Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Yesterday
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.

Neural network model predicts death among patients on liver transplant waitlist

Stephen Padilla
19 Nov 2020
Patients with a higher MELD score are given priority for a liver transplant.

A type of machine learning algorithm using neural networks (NN) appears more accurate than the older model for end-stage liver disease (MELD) scoring in predicting mortality among patients on the liver transplant (LT) waitlist, according to a study.

“The MELD-Na score, which consists of four variables—serum total bilirubin, international normalized ratio, creatinine, and sodium level—was designed to predict the severity of liver disease… However, the current MELD-Na score-based allocation model has lots of limitations,” said co-author Shunji Nagai, a transplant surgeon at Henry Ford Hospital and Henry Ford Cancer Institute in Detroit, who presented the study at The Liver Meeting Digital Experience by the American Association for the Study of Liver Diseases (AASLD 2020).

“We have seen many liver cirrhosis patients whose MELD scores were low but suffered from life-threatening complications due to liver cirrhosis and actually could not have a chance of a liver transplant,” he added.

Nagai and his team used data from the United Network for Organ Sharing’s Organ Procurement and Transplantation Network (OPTN/UNOS) registry, which included records for 194,299 patients listed for LT between 27 February 2002 and 31 December 2018. They used data subsets to generate four separate NN models, which were created to predict mortality at different timeframes: 30, 90, 180, and 365 days. Patients who received LT before the outcome timeline, with liver cancer, who received MELD exceptions, and were listed for combined organ transplants other than kidney were excluded.

The researchers then combined the Liver Data and the Liver Wait List History files in the OPTN/UNOS registry to select a total of 44 variables, including recipient characteristics, trend of liver and kidney function during waiting time, UNOS regions, and registration year. The NN model did not include age, ethnicity, and gender to avoid assigning waitlist priority based on these factors.

Using random sampling, Nagai and colleagues split the data for each model into training, validation, and test dataset in a 60:20:20 ratio. They evaluated the performance of the models using area under receiver operative curve (AUC-ROC) and area under precision-recall curve (PR-AUC).

The AUC-ROC according to NN prediction models was 0.949 for 30-day, 0.928 for 90-day, 0.915 for 180-day, and 0.899 for 365-day mortality, while the PR-AUC was 0.689, 0.730, 0.769, and 0.823, respectively.  [AASLD 2020, abstract 3]

The 90-day mortality NN model outperformed the MELD score for both AUC-ROC and PR-AUC, as well as for recall (sensitivity), negative predictive value (NPV), and F-1 score. Specifically, the 90-day mortality model predicted more waitlist deaths, with a higher sensitivity of 0.833 compared with 0.308 for the MELD score (p<0.001). Conversely, the MELD score showed better accuracy for specificity and precision.

Of note, the researchers compared the performance metrics by breaking the test dataset into multiple subsets based on age, gender, ethnicity, region, diagnosis group, and listing year. The 90-day mortality model performed significantly better than the MELD scores across all subsets of data for predicting waitlist mortality.

“In the future, if these advanced technologies are introduced into the liver allocation system, liver waitlist ranking would better reflect patients’ medical urgency and this should lead to lower waitlist mortality,” Nagai said.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Pearl Toh, 26 Nov 2020
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Yesterday
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.