Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

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Abstract

Background & Aims Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS, 80%–100%), 43% were in category B (KPS, 50%–70%), and 13% were in category C (KPS, 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.

Original languageEnglish (US)
Pages (from-to)1189-1195.e1
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Karnofsky Performance Status
Fibrosis
Mortality
Liver Transplantation
Confidence Intervals

Keywords

  • Death
  • Liver Disease
  • Survival
  • UNOS
  • Waitlist

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{08a7bb4a22e9428abfeb8a52411e3d6c,
title = "Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis",
abstract = "Background & Aims Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44{\%} were in KPS category A (KPS, 80{\%}–100{\%}), 43{\%} were in category B (KPS, 50{\%}–70{\%}), and 13{\%} were in category C (KPS, 10{\%}–40{\%}). Between 2005 and 2015, the proportion of patients in category A decreased from 53{\%} to 35{\%}, whereas the proportions in categories B and C increased from 36{\%} to 49{\%} and from 11{\%} to 16{\%}, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95{\%} confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95{\%} CI, 1.55–1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95{\%} CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95{\%} CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.",
keywords = "Death, Liver Disease, Survival, UNOS, Waitlist",
author = "Eric Orman and Marwan Ghabril and Naga Chalasani",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.cgh.2016.03.036",
language = "English (US)",
volume = "14",
pages = "1189--1195.e1",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "8",

}

TY - JOUR

T1 - Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

AU - Orman, Eric

AU - Ghabril, Marwan

AU - Chalasani, Naga

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background & Aims Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS, 80%–100%), 43% were in category B (KPS, 50%–70%), and 13% were in category C (KPS, 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.

AB - Background & Aims Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS, 80%–100%), 43% were in category B (KPS, 50%–70%), and 13% were in category C (KPS, 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.

KW - Death

KW - Liver Disease

KW - Survival

KW - UNOS

KW - Waitlist

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U2 - 10.1016/j.cgh.2016.03.036

DO - 10.1016/j.cgh.2016.03.036

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C2 - 27046483

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SP - 1189-1195.e1

JO - Clinical Gastroenterology and Hepatology

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SN - 1542-3565

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