Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores

Radisavljevic, Mirjana; Bjelaković, Goran; Nagorni, Aleksandar; Stojanović, Miroslav; Radojkovicn, Milan D; Jovic, Jasna; Ignjatović, Aleksandra; Radisavljević, Miša; Simonovic, Maja M

doi:10.1159/000451057

Cited by 10 publications

(8 citation statements)

References 31 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, because most major complications occurring in cirrhotic patients do require in‐patient admission, we feel that this study is reflective of the general population. We also noted that the admission MELD score for our population is lower than expected compared to other academic medical centres, 36,37 possibly limiting the generalisability of our results. However, this may also reflect the benefits of NSBBs in patients in less advanced stages of cirrhosis.…”

Section: Discussioncontrasting

confidence: 67%

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Sasso

Rockey

2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundNon‐selective beta‐blockers (NSBBs) reduce enteric bacterial translocation rates and the frequency of spontaneous bacterial peritonitis (SBP) in animal models.AimTo evaluate the effect of NSBBs on infection‐related admissions.MethodsWe performed a case‐control study of cirrhotic patients' first in‐patient admission between 1 January 2011 and 31 December 2016. We examined NSBB use and the development of infection. We performed a propensity score‐matched analysis in those with NSBB use vs no use and calculated odds ratios on this matched cohort to determine the odds of outcomes based on NSBB use.ResultsWe identified 2165 cirrhotic patients who met our inclusion criteria. Most patients were Caucasian (69%), male (62%). Admission Model for End stage Liver Disease (MELD) score, Charlson comorbidity index and Child‐Pugh score were 12 ± 1, 4 ± 2, and 8 ± 2, respectively. Ascites was the most common complication of portal hypertension (44%); 23% of patients used NSBBs at home. Infections occurred in 33% of admissions. In the propensity score‐matched cohort, the use of NSBBs at home was associated with lower overall, and specific, infections. The effect was similar in patients taking NSBBs for either primary or secondary oesophageal variceal prophylaxis and for those on NSBBs for other indications. Patients not on NSBBs had higher odds of infection (OR = 2.5), SBP (OR = 4.0), and bacteraemia (OR = 6.0).ConclusionHome use of NSBBs by patients with cirrhosis was associated with fewer infection‐related admissions. The data suggest that NSBBs in this group of patients reduce the risk of infection.

show abstract

Section: Discussioncontrasting

confidence: 67%

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Sasso

Rockey

2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Sixteen eligible[20-35] studies involving 2337 decompensated liver cirrhosis patients were included in this meta-analysis, and the flow diagram for the selection of the articles is shown in Figure 3.…”

Section: Resultsmentioning

confidence: 99%

Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

Zheng

Tian

et al. 2018

WJCC

View full text Add to dashboard Cite

AIMTo compare the accuracy of the scoring systems Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease score (MELD), MELD-Na, and MELD to Serum Sodium ratio (MESO) to predict the mortality in decompensated liver cirrhosis.METHODSThe PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4.RESULTSSixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves (AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81, 0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELD-Na at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively.CONCLUSIONMESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELD-Na has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.

show abstract

“…Liver stiffness measurement (LSM) score, duration of alcohol consumption, and AST to platelet ratio index (APRI) in different stages of fibrosis Non-invasive assessment of liver fibrosis in alcoholic liver disease the median being in the CTP class B. In a study by Radisavljevic et al in cirrhotic patients, the CTP score was associated with higher mortality [18]. The mean LSM was 17.65 kPa and suggestive of significant fibrosis (stage F3).…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Radisavljevic et al . in cirrhotic patients, the CTP score was associated with higher mortality [ 18 ]. The mean LSM was 17.65 kPa and suggestive of significant fibrosis (stage F3).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive assessment of liver fibrosis in alcoholic liver disease

Husain¹,

Chiwhane²,

Kirnake³

2020

ceh

View full text Add to dashboard Cite

Aim of the study: To assess the severity of fibrosis in patients with alcoholic liver disease (ALD) by a non-invasive method (transient elastography-TE). Material and methods: A cross sectional study was conducted on 130 cases of ALD over a period of 2 years. Upper gastrointestinal (GI) endoscopy and transient elastography were done. Liver fibrosis was staged with the METAVIR system and severity of fibrosis was correlated with complications, duration of alcohol abuse, aspartate transaminase (AST) to platelet ratio index (APRI) and Child-Turcotte-Pugh (CTP) score. To establish the relationship between various parameters, Spearman's correlation coefficient (r) and their associated probability (p) were used. Results: Distribution in 130 patients according to the METAVIR stage (median liver stiffness measurement [LSM]) was: F0: n = 16 (5.08 kPa); F1: n = 19 (6.6 kPa); F2: n = 9 (9.3 kPa); F3: n = 26 (16.3 kPa) and F4: n = 60 (50.5 kPa) (p < 0.0001). Liver stiffness measurement (LSM) score was significantly correlated with CTP score (r = 0.492, p < 0.0001), APRI (r = 0.435, p < 0.0001), duration of alcohol consumption (r = 0.816, p < 0.0001), presence of ascites (r = 0.756, p < 0.0001), presence of esophageal varices (r = 0.567, p < 0.0001), and presence of variceal bleeding (r = 0.383, p < 0.0001). Conclusions: TE is an inexpensive and non-invasive modality to assess the severity of liver fibrosis in ALD. It can be used as a good screening tool to identify patients with cirrhosis without the use of invasive liver biopsy, enabling better prognostication for the development of complications.

show abstract

Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores

Cited by 10 publications

References 31 publications

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

Non-invasive assessment of liver fibrosis in alcoholic liver disease

Contact Info

Product

Resources

About