{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:40:51Z","timestamp":1791330051598,"version":"4.3.1"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chang Gung Medical Research Projects","award":["CORPG3J0071, CMRPG3H0431, CMRPG3H 0432"],"award-info":[{"award-number":["CORPG3J0071, CMRPG3H0431, CMRPG3H 0432"]}]},{"DOI":"10.13039\/501100001868","name":"National Science Council","doi-asserted-by":"publisher","award":["NMRPG3H6041"],"award-info":[{"award-number":["NMRPG3H6041"]}],"id":[{"id":"10.13039\/501100001868","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Classification of cirrhosis based on clinical stages is rapid and based on five stages at present. Two other relevant events, hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), can be considered in a clinical perspective but no study has implemented a seven-stage classification and confirmed its value before. In addition, long-term validation of the Model for End-Stage Liver Disease (MELD) in large cohorts of patients with cirrhosis and comparison with clinical findings are insufficient. Therefore, we performed a study to address these items. From the Chang-Gung Research Database (CGRD), 20,782 patients with cirrhosis were enrolled for an historical survival study. The MELD score, the five-stage clinical score (i.e., occurrence of esophageal varices (EV), EV bleeding, ascites, sepsis) and a novel seven-stage clinical score (i.e., occurrence of EV, EV bleeding, ascites, sepsis, HE, SBP) were compared with their Cox models by receiver operating characteristic (ROC) analysis. The addition of HE and SBP to the seven-stage model had a 5% better prediction result than the five-stage model did in the survival ROC analysis. The result showed that the seven clinical stages are associated with an increased risk for mortality. However, the predicted performances of the seven-stage model and MELD system are likely equivalent. In conclusion, the study (i) proved that clinical staging of cirrhosis based on seven items\/stages had higher prognostic value than the five-stage model and (ii) confirmed the validity of the MELD criteria vs. clinical assessment.<\/jats:p>","DOI":"10.3390\/jpm10040186","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T20:51:00Z","timestamp":1603399860000},"page":"186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Hepatic Encephalopathy and Spontaneous Bacterial Peritonitis Improve Cirrhosis Outcome Prediction: A Modified Seven-Stage Model as a Clinical Alternative to MELD"],"prefix":"10.3390","volume":"10","author":[{"given":"Chien-Hao","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"},{"name":"College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao-Jung","family":"Tseng","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-7599","authenticated-orcid":false,"given":"Piero","family":"Amodio","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Ling","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Fu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Hung","family":"Chang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan"},{"name":"Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"},{"name":"Department of Cardiology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen-Yung","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"},{"name":"College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-3190","authenticated-orcid":false,"given":"Chun-Yen","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan"},{"name":"College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Causes of Death Collaborators (2018). 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