Gray-zone approach for prognostic scoring in non-cancer-related end-stage liver disease: a multicenter retrospective cohort study

A novel prognostic score has been created to facilitate early implementation of palliative care for end-stage liver disease (ESLD) patients. However, the diagnoses of inconclusive patients remain unclear. Hence, we aimed to investigate the clinical thresholds of specific prognostic scores using the gray-zone approach. This is a multicenter, retrospective secondary analysis of an existing dataset. A total of 4,080 admission and outpatient cases were analyzed, and the performances of end-stage liver disease (MELD), MELD-Na, and other specific prognostic scores were compared. We compared the clinical characteristics between the mortality and non-mortality groups. The specific score ranged between 63.4 and 83.3 points in the gray-zone intervals. Total bilirubin could not be used as a biomarker because of its no significance in gray-zone patients. In addition to total bilirubin, age, serum albumin concentration, serum creatinine concentration, and the international normalized ratio may be used to predict mortality in indeterminate-risk patients with noncancer liver cirrhosis.