MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study

Botta, Federica; Giannini, Edoardo G.; Romagnoli, Paola; Fasoli, Alberto; Malfatti, Federica; Chiarbonello, Bruno; Testa, Emanuela; Risso, Domenico; Colla, Giancarlo; Testa, Roberto

doi:10.1136/gut.52.1.134

Cited by 308 publications

(241 citation statements)

References 36 publications

(25 reference statements)

Supporting

Mentioning

212

Contrasting

Unclassified

Order By: Relevance

“…A et al [21], in contrast to several studies that have not objectified significant association between age and mortality [22] [23].…”

Section: Discussionmentioning

confidence: 50%

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

Charif¹,

Saâda²,

Mellouki³

et al. 2014

OJGas

View full text Add to dashboard Cite

Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and socio-demographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm 3 ), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.

show abstract

“…A et al [21], in contrast to several studies that have not objectified significant association between age and mortality [22] [23].…”

Section: Discussionmentioning

confidence: 50%

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

Charif¹,

Saâda²,

Mellouki³

et al. 2014

OJGas

View full text Add to dashboard Cite

show abstract

“…Kamath et al [26] suggested that MELD was a reliable measure of short-term mortality risk in patients with end-stage liver disease of diverse etiology and severity. A study evaluating the prognostic ability of MELD in predicting mortality, Botta et al [27] implied that MELD scoring system for both short and medium term survival was correlated with the degree of liver functional impairment. In a study of 172 cirrhotic patients with AVH and hepatocellular carcinoma, Amitrano et al [20] stratified MELD into high risk group (MELD > 15) and low risk group (MELD ≤ 15), proposed that patients with MELD score > 15 and hepatocellular carcinoma had a significantly worse survival than patients with MELD ≤ 15 and without HCC or with early HCC either at 6 weeks or 3 months.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

View full text Add to dashboard Cite

Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana'a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endo-scope (P < 0.0001), high serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks factors remained in multivariate analysis as significant predictors of early rebleeding were clot on varix (OR: 11.6, CI: 2.87 -47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 -1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P < 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), A. Y. Hunaysh 215 CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD score (≥19) (OR: 1.3, CI: 1.12 -1.41, P < 0.0001) and WBCs over 10.3 × 10 9 /l (OR: 1.2, CI: 1.02 -1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10 9 /l.

show abstract

“…5 Similarly, complications of cirrhosis and portal hypertension such as ascites, variceal bleeding, or hepatic encephalopathy being components of CTP score did not significantly add to accuracy of MELD score suggesting that these complications usually reflect the status of underlying liver function. 26 …”

Section: Other Variablesmentioning

confidence: 99%