Prediction and Diagnosis of Infection in Acutely Decompensated Cirrhosis Patients: Value of MELD Score

2019 ◽  
Author(s):  
Shahid Habib ◽  
Nehali Patel ◽  
Sandeep Yarlagadda ◽  
Sarah N. Patel ◽  
Lindsey M. Schader ◽  
...  
Keyword(s):  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Diagnosis Of Infection

scholarly journals COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324879
Author(s):  
Luca Saverio Belli ◽  
Christophe Duvoux ◽  
Paolo Angelo Cortesi ◽  
Rita Facchetti ◽  
Speranta Iacob ◽  
...  
Keyword(s):  
Liver Disease ◽  
Respiratory Failure ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
End Stage Liver Disease ◽  
Significant Difference ◽  
End Stage ◽  
The Impact

ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

scholarly journals Serum lactate level predicts 6-months mortality in hospitalized patients with decompensated cirrhosis

2019 ◽  
Author(s):  
Yue Zhang ◽  
Yuan Nie ◽  
Si-Zhe Wan ◽  
Cong Liu ◽  
Xuan Zhu
Keyword(s):  
Lactate Level ◽  
Multivariate Analyses ◽  
Predictive Accuracy ◽  
Roc Curves ◽  
Serum Lactate ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Serum Lactate Level ◽  
Initiation Of Therapy ◽  
Prediction Of Prognosis

Abstract Background The prediction of prognosis is an important part of management in decompensated cirrhosis (DeCi) patients with high long-term mortality. Lactate is a known predictor of outcome in critically ill patients. The aim of this study was to assess the prognostic value of lactate in DeCi patients.Methods We performed a single-center, observational, retrospective study of 456 DeCi patients extracted from hospitalization. Univariate and multivariate analyses were used to determine whether lactate was independently associated with the prognosis of DeCi patients. The AUROC was calculated to assess the predictive accuracy compared with existing scores.Results Serum lactate level was significantly higher in nonsurviving patients than in surviving patients. Univariate and multivariate analyses demonstrated that lactate was a risk-independent factor 6-months mortality (odds ratio: 1.412, P=0.001). ROC curves were drawn to evaluate the prediction efficiencies of lactate for 6-months mortality (AUROC: 0.716, P<0.001). Based on our patient cohort, the new scores (MELD+ lactate score, Child-Pugh+ lactate score) had good accuracy for predicting 6-months mortality (AUROC=0.769, P<0.001; AUROC= 0.766, P<0.001). Additionally, the performance of the new scores was superior to those of existing scores (all P < 0.001).Conclusion Serum lactate at admission may be useful for predicting 6-months mortality in DeCi patients, and the predictive value of the MELD score and Child-Pugh score were improved by adjusting lactate. Lactate should be part of the rapid diagnosis and initiation of therapy to improve clinical outcome.

Treatment of patients with decompensated cirrhosis with DAAs improves clinical symptoms without affecting their MELD score

2018 ◽  
Vol 68 ◽  
pp. S549
Author(s):  
J. Romano ◽  
O. Sims ◽  
J. Richman ◽  
M. Tansia ◽  
M. Shoreibah ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Meld Score ◽  
Decompensated Cirrhosis

Profile of Acute Kidney Injury in Patients with Decompensated Cirrhosis at a Tertiary-Care Center in Uttarakhand, India

2019 ◽  
Vol 38 (4) ◽  
pp. 335-343
Author(s):  
Manjot S. Arora ◽  
Reshma Kaushik ◽  
Shahbaj Ahmad ◽  
Rajeev Mohan Kaushik
Keyword(s):  
Acute Kidney Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Total Leucocyte Count ◽  
Bacterial Peritonitis ◽  
Ctp Score

Objectives: To study the clinical profile and predictors of acute kidney injury (AKI) in patients with decompensated cirrhosis. Materials and Methods: This observational study was conducted at Himalayan Institute of Medical Sciences, Dehradun, India, on 175 consecutive patients with decompensated cirrhosis. Patients were studied for AKI as per International Club of Ascites-AKI criteria. Results: The prevalence of AKI was 40.6%, with prerenal AKI 67.6%, hepatorenal syndrome (HRS) 23.8%, intrinsic renal AKI 7%, and postrenal AKI 1.4%. Mean arterial pressure (MAP), platelet count, and serum albumin were significantly lower and total leucocyte count (TLC), blood urea nitrogen, serum creatinine (SCr), total bilirubin, aspartate aminotransferase, international normalized ratio, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score higher in cirrhosis patients with AKI than without AKI (p < 0.05 each). MAP, hemoglobin, TLC, and SCr were significantly different in various types of AKI (p < 0.05 each). AKI had a significant association with CTP score, alcohol, spontaneous bacterial peritonitis (SBP), sepsis, and shock (p < 0.05 each). Type of AKI had significant association with SBP, sepsis, and shock (p < 0.05 each). Mortality occurred in 33.8% patients with AKI with 64.7% mortality in patients with HRS. Outcome had significant association with AKI, stage and type of AKI (p < 0.05 each). Multivariate analysis showed SBP, sepsis, and shock as independent predictors of AKI (p < 0.05 each). Conclusions: AKI occurred commonly in patients with decompensated cirrhosis. Prerenal AKI and HRS were the most common types of AKI. SBP, sepsis, and shock were important predictors of AKI.

scholarly journals Association of Low High-Density Lipoprotein Cholesterol Levels with Poor Outcomes in Hepatitis B-Associated Decompensated Cirrhosis Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xia He ◽  
XiaoYun Liu ◽  
SongQing Peng ◽  
Zhong Han ◽  
Jianjiang Shen ◽  
...  
Keyword(s):  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Roc Curve ◽  
Density Lipoprotein ◽  
Meld Score ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Decompensated Cirrhosis ◽  
Area Under Roc Curve ◽  
Poor Outcomes

Background. Lipid levels become decreased in cirrhotic patients and are correlated with disease severity. In the present study, we investigated the impact of serum high-density lipoprotein cholesterol (HDL-C) on prognosis in patients with HBV-associated decompensated cirrhosis (HBV-DeCi). Methods. The medical records of 153 HBV-DeCi patients were analyzed. Patients were separated into survivors and nonsurvivors according to their 30-day survival. Univariate and multivariate analyses were performed to identify predictors of poor outcomes, and the performance of these predictors was evaluated by receiver operating characteristic (ROC) curve analysis. Results. The 30-day mortality in the cohort was 18.9%. HDL-C levels differed markedly between survivors and nonsurvivors. On multivariate analysis, Model for End-stage Liver Disease (MELD) score and HDL-C level were identified as independent risk factors for mortality in HBV-DeCi patients. In the ROC analyses, the prognostic accuracy for mortality was similar between HDL-C (area under ROC curve: 0.785) and MELD score (area under ROC curve: 0.853). Conclusions. Low HDL-C level had a significant correlation with mortality in HBV-DeCi patients and can be used as a simple marker for risk assessment and selection of therapeutic options.

scholarly journals Correlation between MELD and UNa/K ratio in predicting renal dysfunction in cirrhotic patients

2018 ◽  
Vol 6 (4) ◽  
pp. 181-184
Author(s):  
Jawaid Iqbal ◽  
Muhammad Ali Khalid ◽  
Farina M. Hanif ◽  
Rajesh Mandhwani ◽  
Syed Mudassir Laeeq ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Large Scale ◽  
Surrogate Marker ◽  
Inverse Correlation ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Urinary Potassium ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Ctp Score

Abstract Background Renal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients. Patients and Methods All consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients’ department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0). Results A total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6–14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8–43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37–5.3) and 133.79 ± 6.9 mmol/L (range: 112–152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5–181) and 38.15 ± 23.9 mmol/L (range: 4.3–112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, P = 0.004). Conclusion The inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.

scholarly journals Assessing the Prognostic Performance of the Child-Pugh, Model for End-Stage Liver Disease, and Albumin-Bilirubin Scores in Patients with Decompensated Cirrhosis: A Large Asian Cohort from Gastroenterology Department

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Si-Zhe Wan ◽  
Yuan Nie ◽  
Yue Zhang ◽  
Cong Liu ◽  
Xuan Zhu
Keyword(s):  
Liver Disease ◽  
Roc Curve ◽  
Meld Score ◽  
The Other ◽  
Decompensated Cirrhosis ◽  
Short Term ◽  
End Stage Liver Disease ◽  
End Stage

Background and Aim. Various methods, including the Child-Pugh score, the model for end-stage liver disease (MELD) score, the MELD combined with serum sodium concentration (MELD-Na) score, the integrated MELD (iMELD) score, and the albumin-bilirubin (ALBI) score, have been widely used for predicting the survival of decompensated cirrhosis (DeCi) patients. In this study, we defined and compared the prognostic value of these scores to predict mortality in DeCi patients. Methods. We performed a single-center, observational retrospective study and analyzed 456 DeCi patients who were hospitalized in the gastroenterology department. The biochemical examination results and demographic characteristics of the patients were obtained, and five scores were calculated upon admission after 24 hours. All patients were observed until death, loss to follow-up, or specific follow-up times (28 days, 90 days, and 6 months). A receiver operating characteristic (ROC) curve was used to evaluate the ability of these methods to predict mortality in DeCi patients. Results. At 28 days, 90 days, and 6 months, the cumulative number of deaths was 50 (11.0%), 76 (16.6%), and 91 (19.9%), respectively. The scores were significantly higher in nonsurviving patients than in surviving patients. All scores yielded viable values in predicting 28-day, 90-day, and 6-month prognoses for DeCi patients. The areas under the ROC curve (AUROCs) of the ALBI score were higher than those of the other scores, which were only over 0.700 at 28 days. The AUROC of the MELD score was higher than that of the other scores, including the MELD-Na and iMELD scores, at 90 days and 6 months. Conclusion. All five methods (Child-Pugh score, MELD score, MELD-Na score, iMELD score, and ALBI score) provided a reliable prediction of mortality for both the short-term and long-term prognosis of patients with DeCi. The ALBI score may be particularly useful for assessing short-term outcomes, whereas the MELD score may be particularly useful for assessing long-term outcomes.

scholarly journals Identification of Maltase Glucoamylase as a Biomarker of Acute Kidney Injury in Patients with Cirrhosis

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Linda Awdishu ◽  
Shirley Tsunoda ◽  
Michelle Pearlman ◽  
Chanthel Kokoy-Mondragon ◽  
Majid Ghassemian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Meld Score ◽  
Functional Change ◽  
Decompensated Cirrhosis ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
Urinary Exosomes ◽  
History Of

Background. Acute kidney injury (AKI) is a frequent complication of decompensated cirrhosis with increased mortality. Traditional biomarkers such as serum creatinine are not sensitive for detecting injury without functional change. We hypothesize that urinary exosomes potentially carry markers that differentiate the type of kidney injury in cirrhotic patients. Methods. This is a prospective, single-center, and observational study of adult patients with cirrhosis. The patient groups included healthy normal controls, compensated cirrhosis with normal kidney function, decompensated cirrhosis with normal kidney function, and decompensated cirrhosis with AKI. Data were extracted from the electronic health record including etiology of liver disease, MELD score, history of decompensation, Child-Turcotte-Pugh score, history of AKI, and medication exposures. Urine samples were collected at the time of consent. Urine exosome protein content was analyzed, and proteomic data were validated by immunoblotting. Statistical analysis included partial least squares-discriminant analysis coupled with variable importance in projection identification. Results. Eighteen cirrhotic subjects were enrolled, and six healthy control subjects were extracted from our biorepository. Urine exosomes were isolated, and 1572 proteins were identified. Maltase-glucoamylase was the top discriminating protein confirmed by western blotting. Conclusions. Patients with cirrhosis and AKI have upregulation of renal brush border disaccharidase, MGAM, in urinary exosomes which may differentiate the type of kidney injury in cirrhosis; however, the clinical significance of this requires further validation.

Stereotactic body radiotherapy for hepatocellular carcinoma in the setting of poor liver function: A case series.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 493-493
Author(s):  
Vladimir Valakh ◽  
Graeme Williams
Keyword(s):  
Hepatocellular Carcinoma ◽  
Stereotactic Body Radiotherapy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Distant Metastases ◽  
Hepatic Function ◽  
Target Volume ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Therapy Targets

493 Background: Role of stereotactic body radiotherapy (SBRT) to the liver for patients with poor hepatic function after transcatheter arterial chemoembolization (TACE) has not been established. We reviewed results of SBRT for men with hepatocellular carcinoma (HCC) and Child-Pugh (CP) score ≥ 8 cirrhosis after TACE. Methods: Following a median of 3 TACE treatments, five males with severe cirrhosis received SBRT for persistent or progressive HCC in 2011-14. Clinico-pathologic characteristics and treatment details were retrospectively retrieved. Results: Median age at diagnosis was 55 years (range, 48 – 55). Median interval between cancer diagnosis and SBRT was 38 months (range, 3 – 60). All 5 patients experienced decline in CP score after TACE, for a median of drop of 1 point (range, 1 – 3) between the initiation of TACE and referral for radiotherapy. At time of SBRT, 4 had CP class B and 1 class C cirrhosis with median CP score of 9 (range, 8 – 11). There were no distant metastases and one patient had extrahepatic tumor extension. Three of 5 exhibited clinical symptoms of decompensated cirrhosis within 30 days before radiotherapy and one had portal vein thrombosis. Median MELD score at SBRT was 15 (range, 12 – 18). SBRT to a median total dose of 27.5 Gray (range, 27.5 – 30) was delivered in 5 once daily fractions. Median radiotherapy course duration was 9 days (range, 5 – 18). All patients had single radiation therapy targets with median largest tumor dimension of 3.6 cm (range, 2.4 – 6.2). Median planned target volume was 24 cm3(range, 17 – 197). Sorafenib was given prior to SBRT to one patient, concurrently to one, and sequentially after radiotherapy to another. There were no acute complications. Two patients died within 20 days from completion of SBRT. Median follow up for surviving > 20 days was 10 months (range, 5 – 13). None experienced radiographic tumor progression after radiotherapy. Estimated overall survival was 40% at 6 months (95% confidence intervals, 0 – 83.8%). Conclusions: For HCC patients with CP score ≥ 8 following TACE, prognosis after liver SBRT was poor.

Phase 1 Human Trial of Autologous Mesenchymal Stem Cell Transplantation for the Treatment of Decompensated Cirrhosis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4864-4864
Author(s):  
Kamran Alimoghaddam ◽  
Mehdi Mohamadnejad ◽  
Mohahamd Bagheri ◽  
Maryam Bashtar ◽  
Hossein Ghannati ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Liver Volume ◽  
Liver Function Tests ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Peripheral Vein ◽  
Hematopoietic Stem ◽  
Human Trial

Abstract INTRODUCTION: Liver transplantation is the standard treatment in decompensated cirrhosis; however, it has several limitations including high cost, and several complications. Recent animal works have shown that mesenchymal stem cell (MSC) infusion through the rat tail vein can lead to regression of liver fibrosis. But there has been no human trial of autologous MSC transplantation (Tx) in cirrhosis. The aim of this study was to evaluate safety and feasibility of MSC transplantation in decompensated cirrhosis. In a recent study, infusion of CD 34+ (e.g. hematopoietic stem cells) through the hepatic artery was used to treat cirrhosis. However, we infused MSCs (e.g. non-hematopoietic stem cells) through a peripheral vein. AIMS & METHODS: After protocol approval by the ethic committee, four patients with decompensated cirrhosis were included. 100 ml of their bone marrow was aspirated and MSCs were cultured. After two months culture, 10 to 70 million MSCs obtained which 95% of the cells were viable (as assessed by trypan blue method) and 95% of the cells were morphologically and immunophenotypically MSCs. The MSCs were infused through a peripheral vein. Outcomes were changes in liver function tests, MELD score, and liver volume (as measured by CT volumetry) 5 months after Tx. During follow up, patients’ medications (e.g duretics, or propranolol) remained the same as before MSCs Tx. RESULTS: Four patients (1 male, 3 female) aged 30 to 56 were included. The etiology of cirrhosis was autoimmune hepatitis or cryptogenic. The follow up for the first patient has been completed, and other 3 patients have 2.5 to 4 months of follow up. In first patient, PT (18.5 to 13 seconds), and albumin (2.9 to 3.8 g/dL) normalized, and MELD score was decreased from 16 to 11. Her liver volume increased from 495 to 815 ml. In patient 2, PT decreased from 20.1 to 17.5. In patient 3, PT decreased from 19.1 to 15.7 seconds, and MELD score decreased from 17 to 14. Patient 4 has not yet been shown any significant improvement in liver function tests. The procedure was safe, and there was no any adverse effect. CONCLUSION: MSCs Tx is a novel approach to treat cirrhosis. For the first time, we showed that this procedure is safe and feasible, and signs of improvement found in some of our patients are promising.

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