scholarly journals Comparing Mortality Risk Predictive Ability of Different Scoring Systems in Cirrhotic Patients with Bacteremia

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chi-Chieh Hung ◽  
Yin-Chou Hsu ◽  
Kuo-Hsuan Lin
Keyword(s):  
Liver Cirrhosis ◽  
Mortality Risk ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Meld Score ◽  
Lower Proportion ◽  
Discriminative Ability ◽  
Survivor Group ◽  
Cirrhotic Patients ◽  
Qsofa Score

Patients with liver cirrhosis and bacteremia have substantially higher risk of mortality and morbidity. Our study aimed to investigate scoring systems that can predict the mortality risk in patients with cirrhosis and bacteremia. A single-center, retrospective cohort study was performed among adult patients who visited the emergency department from January 2015 to December 2018. All patients diagnosed with liver cirrhosis and bacteremia were enrolled and divided into survivor and nonsurvivor groups for comparison based on their 30-day in-hospital mortality event. The Pitt bacteremia score (PBS), model for end-stage liver disease (MELD) score, Child–Pugh score, and quick sequential Organ Failure Assessment (qSOFA) score were calculated and compared using the area under the receiver operating characteristic (AUROC) curves. A total of 127 patients (survivor: 86; nonsurvivor: 41) were eligible for this study. Compared with the nonsurvivor group, patients in the survivor group had significantly lower MELD score (22 ± 7 vs. 29 ± 5, p < 0.001 ), lower proportion of high qSOFA (score ≥ 2) (23.3% vs. 51.2%, p < 0.01 ), and high PBS (score ≥ 4) (7.0% vs. 34.1%, p < 0.001 ) category. There was also a significantly different distribution in Child–Pugh classification between the two groups p < 0.01 . The survivor group had significantly lower proportion of acute-on-chronic liver failure (27.9% vs. 68.3%, p < 0.001 ) and fewer number of organ failures p < 0.001 . In comparison of the discriminative ability in mortality risk prediction, PBS (AUROC = 0.83, 95% CI = 0.75–0.90, p < 0.001 ) and MELD scores (AUROC = 0.78, 95% CI = 0.70–0.86, p < 0.001 ) revealed a better predictive ability than Child–Pugh (AUROC = 0.69, 95% CI = 0.59–0.70, p < 0.01 ) and qSOFA scores (AUROC = 0.65, 95% CI = 0.54–0.75, p < 0.01 ). PBS and MELD scores both demonstrated a superior ability of predicting mortality risk in cirrhotic patients with bacteremia.

scholarly journals Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed Abdelrahman Mohamed Baz ◽  
Rana Magdy Mohamed ◽  
Khaled Helmy El-kaffas
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Meld Score ◽  
Hepatic Decompensation ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Us Findings ◽  
End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

Prognostic value of AIMS65 score in cirrhotic patients with variceal bleeding

MedPharmRes ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 22-26
Author(s):  
Trong Nguyen Dang Huynh
Keyword(s):  
Variceal Bleeding ◽  
Predictive Value ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Meld Score ◽  
Operating Characteristics ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Ctp Score

Background: In cirrhotic patients, variceal bleeding remains a major cause of death. After a variceal bleeding episode, mortality and rebleeding rates spike for the first 6 weeks before levelling off. We aimed to evaluate the performance of AIMS65 score in comparison with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score in predicting 6-week mortality and rebleeding in cirrhotic patients with variceal bleeding. Method: Data were collected prospectively from patients with cirrhosis and variceal bleeding at Gastroenterology and Hepatology Department of Cho Ray hospital from September 2016 to April 2017. The primary endpoint was 6-week mortality and rebleeding. The prognostic value of AIMS65, CTP, and MELD scoring systems for 6-week mortality and rebleeding was compared by receiver operating characteristics curves (ROC) and the area under the curve (AUC). Results: Among 80 patients, 15% rebled and 25% died during 6-week follow-up. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week rebleeding were 0.68, 0.54, and 0.48, respectively. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week mortality were 0.80, 0.74, and 0.64, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AIMS65 score at the cutoff point of 2 were 95%, 55%, 41.3%, and 97%, respectively. Conclusion: AIMS65 score is a simple yet applicable tool for risk stratification in cirrhotic patients with variceal bleeding. We recommend using AIMS65 score with a cut-off point of 2 to identify patients at increased risk for 6-week mortality after variceal bleeding.

scholarly journals Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View

2019 ◽  
Vol 8 (9) ◽  
pp. 1285 ◽  
Author(s):  
Kun Zhang ◽  
Alexander Braun ◽  
Francisca von Koeckritz ◽  
Rosa B. Schmuck ◽  
Eva M. Teegen ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Meld Score ◽  
Right Atrial ◽  
Alcoholic Liver Cirrhosis ◽  
Basal Diameter ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Longitudinal Strains

Background: Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. Methods: This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. Results: RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. Conclusions: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.

Impact of the COVID-19 pandemic on patients with liver cirrhosis—the experience of a tertiary center in Germany

2021 ◽  
Vol 59 (09) ◽  
pp. 954-960
Author(s):  
Christoph Höner zu Siederdissen ◽  
Marie Schultalbers ◽  
Maximilian Wübbolding ◽  
Greta Sophie Lechte ◽  
Hans Laser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Liver Cirrhosis ◽  
Late Presentation ◽  
Meld Score ◽  
Northern Germany ◽  
Duration Of Symptoms ◽  
Tertiary Center ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Impact

Abstract Background The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established. Objective We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany. Methods All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015–2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19. Results Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms >24 h before presenting to the emergency department. Conclusion Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).

scholarly journals Comparison of illness severity scoring systems for mortality prediction in Neurointensive Care Unit in India

2017 ◽  
Vol 04 (01) ◽  
pp. 042-048
Author(s):  
Sonia Bansal ◽  
Rohini Surve ◽  
Radhakrishnan Muthuchellappan ◽  
Ganne Umamaheswara Rao ◽  
Mariamma Philip
Keyword(s):  
Predictive Power ◽  
Severity Of Illness ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Simplified Acute Physiology Score ◽  
Illness Severity ◽  
Mortality Prediction ◽  
Discriminative Ability ◽  
Severity Scoring ◽  
Mortality Prediction Model

Abstract Background: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality rate was 19.8%, and the scores of all the SSs correlated significantly with GOS (P < 0.001). All the scores were significantly different between survivors and non-survivors. The accuracy of all the SSs to predict survival and non-survival was more than 80%. The highest accuracy rate was seen for GCS and SAPS (84.3% and 83.8%, respectively). Conclusions: The SSs used in this study had good predictive power, and they had good discriminative ability between survivors and non-survivors. GCS and SAPS have the highest predictive ability, GCS having added advantage of being simple and practical.

scholarly journals Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Si-Hai Chen ◽  
Qin-Si Wan ◽  
Ting Wang ◽  
Kun-He Zhang
Keyword(s):  
Liver Cirrhosis ◽  
Venous Pressure ◽  
Meld Score ◽  
Careful Evaluation ◽  
Risk Of Mortality ◽  
Prediction Of Survival ◽  
Prognosis Of Liver Cirrhosis ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Prognostic Functions

Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

scholarly journals Helicobacter pylori Infection in Patients with Portal Hypertensive Gastropathy Owing to Liver Cirrhosis: Prevalence and Relation with Severity of Gastropathy

2017 ◽  
Vol 08 (03) ◽  
pp. 123-128
Author(s):  
Shekhar Puri ◽  
Mukesh Jain ◽  
Kumar Shwetanshu Narayan ◽  
Sudhakar Pandey ◽  
Sandeep Nijhawan
Keyword(s):  
Helicobacter Pylori ◽  
Liver Cirrhosis ◽  
Meld Score ◽  
Upper Gastrointestinal Endoscopy ◽  
Portal Hypertensive Gastropathy ◽  
Cirrhotic Patients ◽  
The Difference ◽  
H Pylori ◽  
Ctp Score ◽  
Upper Gastrointestinal

ABSTRACT Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. ChildαTurcotteαPugh (CTP) and model for endαstage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298–12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pyloriαnegative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188–17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56). Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

scholarly journals Evaluation of Mortality Risk in Liver Cirrhosis with Albumin- Bilirubin (Albi), Platelet-Albumin-Bilirubin (Palbi), and Fibrosis-4 (Fib-4) Scores

2021 ◽  
Vol 14 (02) ◽  
pp. 985-991
Author(s):  
D.A. Sindhughosa ◽  
I.K. Mariadi ◽  
I.D.N. Wibawa ◽  
I.G.A. Suryadarma ◽  
N. Purwadi ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Mortality Risk ◽  
Liver Diseases ◽  
Cross Sectional Study ◽  
Meld Score ◽  
Sectional Study ◽  
Cross Sectional ◽  
End Stage Liver Disease ◽  
End Stage

Background:The model for end stage liver disease (MELD) score considered as a reliable predictor of survival for advanced liver diseases patients. Among several chemistry laboratorium examinations, albumin, bilirubin and platelet reflect the function of the liver. Objectives: To investigate the correlation of albumin-bilirubin (ALBI), platelet-albumin-bilirubin (PALBI), and fibrosis-4 (FIB-4) scores with mortality risk based on MELD score and evaluate their role in predictingcirrhosis mortality risk. Methods: The analytic cross-sectional study designrecruited adults with liver cirrhosis of any etiology during the period of November 2018 through January 2019. Descriptive and correlative analyses were done before proceeding to diagnostic abilityanalysis. Results: Sixty-two patients with mean age of 52.95 ± 12.05 were included in the analysis. The ALBI, PALBI, and FIB-4 scores were significantly correlated with higher mortality risk based on MELD score. The three scoressignificantly predicted higher mortality risk with varying sensitivity and specificity. Conclusion: Positivecorrelation between ALBI, PALBI, and FIB-4 scores with MELD score was found. ALBI (≥-1.26), PALBI (≥-2.05), and FIB-4 (≥5.84) values higher than the thresholdcould predict mortality risk in cirrhosis.

scholarly journals The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding

2009 ◽  
Vol 66 (9) ◽  
pp. 724-728 ◽  
Author(s):  
Daniela Benedeto-Stojanov ◽  
Aleksandar Nagorni ◽  
Goran Bjelakovic ◽  
Dragan Stojanov ◽  
Bojan Mladenovic ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Survival Rate ◽  
Variceal Bleeding ◽  
Meld Score ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Background/Aim. Esophageal variceal bleeding is one of the most frequent and gravest complications of liver cirrhosis, directly life-threatening. By monitoring certain clinical and laboratory hepatocellular insufficiency parameters (Child-Pugh score), it is possible to determine prognosis in patients who are bleeding and evaluate further therapy. Recently, the Model for the End-Stage Liver Disease (MELD) has been proposed as a tool to predict mortality risk in cirrhotic patients. The aim of the study was to evaluate survival prognosis of cirrhotic patients by the MELD and Child-Pugh scores and to analyze the MELD score prognostic value in patients with both liver cirrhosis and variceal bleeding. Methods. We retrospectively evaluated the survival rate of a group of 100 cirrhotic patients of a median age of 57 years. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. We also analyzed clinical and laboratory hepatocellular insufficiency parameters in order to examine their connection with a 15-month survival. The MELD values were correlated with the Child-Pugh scores. The Student's t-test was used for statistical analysis. Results. Twenty-two patients died within 15-months follow-up. Age and gender did not affect survival rate. The Child- Pugh and MELD scores, as well as ascites and encephalopathy significantly differed between the patients who survived and those who died (p < 0.0001). The International Normalized Ratio (INR) values, serum creatinine and bilirubin were significantly higher, and albumin significantly lower in the patients who died (p < 0.0001). The MELD score was significantly higher in the group of patients who died due to esophageal variceal bleeding (p < 0.0001). Conclusion. In cirrhotic patients the MELD score is an excellent survival predictor at least as well as the Child-Pugh score. Increase in the MELD score is associated with decrease in residual liver function. In the group of patients with liver cirrhosis and esophageal variceal bleeding, the MELD score identifies those with a higher intrahospital mortality risk.

scholarly journals Assessment of serum level cholinesterase as a biomarker of liver cirrhosis in Egyptian cirrhotic patients

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Mona A. Amin ◽  
Marwa E. El-Shahat ◽  
Nouman El-Garem ◽  
Ahmed Soliman ◽  
Eman Obaia
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Negative Correlation ◽  
Meld Score ◽  
Serum Cholinesterase ◽  
Control Group ◽  
Strong Negative Correlation ◽  
Compensated Cirrhosis ◽  
Cirrhotic Patients ◽  
End Stage

Serum cholinesterase levels are closely correlated with the severity of liver disease. The aim of the paper was to assess the value of serum cholinesterase in evaluating liver reserve function in cirrhotic patients. 90 patients with liver cirrhosis and thirty healthy control group were included. Liver cirrhosis patients were classified according to child score into three equal groups: Child A liver cirrhosis, Child B liver cirrhosis and Child C liver cirrhosis. Patients were subjected to clinical evaluation, laboratory analysis, abdominal U/S. Measuring serum cholinesterase, and Calculation of both Child and model of end stage liver disease (MELD) scores. The level of serum cholinesterase was higher in control group than the three groups of liver cirrhosis with median (IQR) 17,410 (12,111-21,774), 7528 (5200-9856), 6021 (4500-7542), 3828.5 (1541-6060), respectively P<0.001). And the level of serum cholinesterase was higher in Child A more than Child B and Child C and the level of serum cholinesterase was higher in Child B more than Child C with very strong negative correlation between serum Cholinesterase level and Child score (r=-0.9, P<0.001). Also strong negative correlation between serum Cholinesterase level and MELD score (r=- 0.85, P=0.001), and positive correlation with prothrombin concentration (r=0.554, P=0.009), and serum albumin levels (r=0.582, P=0.0002). Serum cholinesterase is a good biomarker of cirrhosis. Since it distinguishes decompensated from compensated cirrhosis well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease.

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