The bilirubin-lactate-etiology scoring system was developed several years ago in an attempt to improve on the sensitivity and specificity for predicting outcomes in patients waiting for liver transplantation. The model was developed by Dr. Johannes Hadem and his colleagues at Hannover (Germany) Medical School.
Currently in the United States, organs are allocated accordingly to the MELD score (Model for End Stage Liver Disease.)
Although the research published by Hadem shows higher sensitivity and specificity than the MELD score, the study had several serious drawbacks.
Critics point out that the data were gathered in a retrospective manner at a single institution. In addition, etiology of liver failure varies widely globally and the scoring system was not been validated for different regions.
Finally, the study assessed composite risk of death or transplant instead of focusing on mortality risk, thus weakening the argument that it can be used to guide timing of transplant.
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