Model for End-Stage Liver Disease Sodium as a Predictor of Surgical Risk in Cirrhotic Patients With Ascites

Maassel, Nathan; Fleming, Matthew R; Luo, Jiajun; Zhang, Yawei; Pei, Kevin Y.

doi:10.1016/j.jss.2019.12.037

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…Although the exact relationship between sepsis and low serum sodium is not known, an association between infections and hyponatremia has been previously reported [20]. We could not compare our model with other ACLF models, but few studies have shown that hyponatremia may have an additive effect on the mortality risks associated with ACLF [22–25].…”

Section: Discussionmentioning

confidence: 99%

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Thuluvath

Alukal

Zhang

2022

European Journal of Gastroenterology &Amp; Hepatology

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Background and objective Hypervolemic hyponatremia is a late complication of portal hypertension. Hyponatremia is associated with a higher mortality in hospitalized patients. In this study, we evaluated the risk factors for inhospital mortality and developed a mortality prediction model in patients with cirrhosis and hyponatremia. Methods Using the national inpatient sample data for years 2016 and 2017, we identified cirrhotic patients hospitalized with ascites and hyponatremia (n = 9153). We identified independent risk factors of inhospital mortality and developed a prediction model in a training group and assessed its accuracy in a validation group. To enhance the clinical utility, we further stratified patients into low-, intermediate-, and high-risk mortality risk groups using cutoff points selected by decision tree analysis. Results The inhospital mortality in our cohort was 10.2% (n = 846). Multivariable analysis showed that age at least 65 years, variceal bleeding, sepsis, coagulopathy, and acute-on-chronic liver failure (ACLF defined as two or more organ failures) were independent risk factors for mortality. The prediction model using these five risk factors had an AUROC of 0.80 [95% confidence interval (CI), 0.78–0.82] for the training data and 0.83 (95% CI, 0.80–0.86) for the validation data. The mortality risks in the low-, intermediate-, and high-risk groups were 4% (95% CI, 3–4), 29% (95% CI, 28–33), and 43% (95% CI, 37–50), respectively. Conclusion We have developed a clinically meaningful inhospital prognostic model with excellent discrimination that will enable clinicians to risk stratify hospitalized patients with hyponatremia, ascites, and cirrhosis.

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Section: Discussionmentioning

confidence: 99%

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Thuluvath

Alukal

Zhang

2022

European Journal of Gastroenterology &Amp; Hepatology

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“…In this study, a baseline sCr level was included in the hospital survival nomogram, which modified the limitation of the Child–Pugh score not accounting for renal function [ 25 ]. The MELD–Na score was initially used to predict 3- and 6-month mortality among patients with cirrhosis awaiting LT [ 26 , 27 , 28 ]. Moreover, it has now been widely validated as a prognosis predictor of survival in patients with liver diseases [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nomograms for Hospital Survival and Transplant-Free Survival of Patients with Hepatorenal Syndrome: A Retrospective Cohort Study

et al. 2022

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Hepatorenal syndrome (HRS) is a life-threatening complication of cirrhosis with a poor prognosis. To develop novel and effective nomograms which could numerically predict both the hospital survival and transplant-free survival of HRS, we retrospectively enrolled a cohort of 149 patients. A backward stepwise method based on the smallest Akaike information criterion value was applied to select the covariates to be included in the Cox proportional hazards models. The Harrell C-index, area under the receiver operating characteristic curve (AUC), Brier score, and Kaplan–Meier curves with the log-rank test were used to assess nomograms. The bootstrapping method with 1000 resamples was performed for internal validation. The nomogram predicting hospital survival included prothrombin activity, HRS clinical pattern, Child–Pugh class, and baseline serum creatinine. The C-index was 0.72 (95% confidence interval (CI), 0.65–0.78), and the adjusted C-index was 0.72 (95% CI, 0.66–0.79). The nomogram predicting transplant-free survival included sex, prothrombin activity, HRS clinical pattern, model for end-stage liver disease–Na score, and peak serum creatinine. The C-index of the nomogram was 0.74 (95% CI, 0.69–0.79), and the adjusted C-index was 0.74 (95% CI, 0.68–0.79). The AUC and Brier score at 15, 30, and 45 days calculated from the hospital survival nomogram and those at 6, 12, and 18 months calculated from the transplant-free survival nomogram revealed good predictive ability. The two models can be used to identify patients at high risk of HRS and promote early intervention treatment.

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“…У пациентов с циррозом печени (ЦП), по сравнению с общей популяцией, существенно повышены риски хирургических вмешательств [1,2]. Рост рисков ассоциирован с выраженностью портальной гипертензии (ПГ) [3], степенью компенсации ЦП [4], коморбидностью [5], а также видом и экстренностью [1,2] оперативного лечения.…”

Section: Introductionunclassified

Surgical treatment of portal hypertension complications in patients with liver cirrhosis

Дурлештер

Габриэль

Korochanskaya

et al. 2022

Innovacionnaâ medicina Kubani

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Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors.

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Model for End-Stage Liver Disease Sodium as a Predictor of Surgical Risk in Cirrhotic Patients With Ascites

Cited by 4 publications

References 24 publications

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia

Prognostic Nomograms for Hospital Survival and Transplant-Free Survival of Patients with Hepatorenal Syndrome: A Retrospective Cohort Study

Surgical treatment of portal hypertension complications in patients with liver cirrhosis

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