Accurate long-term prediction of death for patients with cirrhosis

David Goldberg, Alejandro Mantero, David Kaplan, Cindy Delgado, Binu John, Nadine Nuchovich, Ezekiel Emanuel, Peter P. Reese

Research output: Contribution to journalReview articlepeer-review


Background and Aims: Cirrhosis is a major cause of death and is associated with extensive health care use. Patients with cirrhosis have complex treatment choices due to risks of morbidity and mortality. To optimally counsel and treat patients with cirrhosis requires tools to predict their longer-term liver-related survival. We sought to develop and validate a risk score to predict longer-term survival of patients with cirrhosis. Approach and Results: We conducted a retrospective cohort study of adults with cirrhosis with no major life-limiting comorbidities. Adults with cirrhosis within the Veterans Health Administration were used for model training and internal validation, and external validation used the OneFlorida Clinical Research Consortium. We used four model-building approaches including variables predictive of cirrhosis-related mortality, focused on discrimination at key time points (1, 3, 5, and 10 years). Among 30,263 patients with cirrhosis ≤75 years old without major life-limiting comorbidities and complete laboratory data during the baseline period, the boosted survival tree models had the highest discrimination, with 1-year, 3-year, 5-year, and 10-year survival rates of 0.77, 0.81, 0.84, and 0.88, respectively. The 1-year, 3-year, and 5-year discrimination was nearly identical in external validation. Secondary analyses with imputation of missing data and subgroups by etiology of liver disease had similar results to the primary model. Conclusions: We developed and validated (internally and externally) a risk score to predict longer-term survival of patients with cirrhosis. This score would transform management of patients with cirrhosis in terms of referral to specialty care and treatment decision-making for non-liver-related care.

Original languageEnglish (US)
StateAccepted/In press - 2022
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology


Dive into the research topics of 'Accurate long-term prediction of death for patients with cirrhosis'. Together they form a unique fingerprint.

Cite this