Resistive Index and MELD-Na: Nephrologic Monitoring in Cirrhotic Patients Awaiting Liver Transplantation

Umbro, I.; Tinti, Francesca; Fiacco, F.; Zavatto, A.; Piselli, Pierluca; Natale, V. Di; Lai, Silvia; Vitarelli, Antonio; Corradini, Stefano Ginanni; Rossi, Massimo; Poli, L.; Berloco, P.; Mitterhofer, Anna Paola

doi:10.1016/j.transproceed.2013.07.040

Cited by 7 publications

(6 citation statements)

References 41 publications

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“…Patients with high MELD score had higher RI. These results also were in agreement with those of Umbro et al [37] and Moustafa et al [34] In this study, Resistive index ROC curve analysis showed that, RI had AUROC = 0.997 and if the Cutoff point of renal RI was 0.71, the sensitivity of the test was 100%, the specificity was 80%, PPV was 44%, NPV was 100% and accuracy was 82%. The results of this study were close to that reported by Abdel-Bary et al [35] who stated that, RI ROC curve analysis showed that RI had AUROC = 0.903 (95% CI: 0.835-0.949 and P<0.001).…”

Section: Between Giii and Gi P2:between Giii And Giia P3:between supporting

confidence: 92%

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

EL-Lehleh

Mageed

et al. 2017

Afro-Egyptian Journal of Infectious and Endemic Diseases

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Background and study aim: Renal dysfunction often develops in patients with liver cirrhosis. Hepatorenal syndrome (HRS) represents the end-stage of reduction in renal perfusion. Duplex Doppler ultrasonography of the kidneys is a noninvasive method to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction. This study aimed to assess the role of renal resistive index as a non-invasive marker for early detection of functional renal impairment in patients with liver cirrhosis. Patients and Methods: This study was conducted on 20 patients with liver cirrhosis without ascites vs. 60 patients with liver cirrhosis and ascites and 20 healthy subjects as control group. Patients and control were subjected to complete blood picture, liver and kidney functions, serum electrolytes, twenty four hours urinary sodium, abdominal ultrasonography and duplex Doppler evaluation of the renal arteries with calculation of mean renal RI. Results: Highly significant difference between cirrhotic patients with ascites and cirrhotic patients without ascites and controls regarding mean renal resistive index for both kidneys (P<0.001). At Cutoff point of renal RI 0.71, the sensitivity, specificity and accuracy to predict HRS were 100%, 80% and 82% respectively with AUC= 0.997. A statistical high significant positive correlation between RI and serum creatinine, child class, MELD score and MELD-Na (r=0. 0.818, r= 0. 0.539, r= 0.739 r= 0.807 respectively and P<0.001). A statistical high significant negative correlation between RI and serum sodium, 24 hours urinary sodium, and platelets (r=-0.778, r= 0.-0.688, r=-0.422 respectively and P<0.001). Conclusion: Renal duplex Doppler ultrasound is useful as a non-invasive method for the evaluation of the renal hemodynamic changes in cirrhotic patients and can predict HRS.

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Section: Between Giii and Gi P2:between Giii And Giia P3:between supporting

confidence: 92%

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

EL-Lehleh

Mageed

et al. 2017

Afro-Egyptian Journal of Infectious and Endemic Diseases

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“…Splenic vascular tone and splenic hemodynamics in portal hypertension are regulated by complex pathways . The specific role of the spleen in portal hypertension, through venous congestion, complex arterial and neural mechanisms, intrasplenic microvascular tone, splenic pre‐ and postcapillary resistance, splenorenal reflex, and production of a vasoactive factor was postulated …”

Section: Discussionmentioning

confidence: 99%

“…MELD score is a predictor of survival in cirrhotic patients awaiting transplantation . It consists of serum bilirubin and serum creatinine concentrations as well as international normalized ratio.…”

Section: Discussionmentioning

confidence: 99%

Doppler assessment of splanchnic arterial flow in patients with liver cirrhosis: Correlation with ammonia plasma levels and MELD score

Glišić¹,

Perišić

Dimitrijevic

et al. 2014

J of Clinical Ultrasound

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“…(7,9) Subsequently, the original MELD was adapted through inclusion of serum sodium (NA) concentrations (MELD-Na), which led to improved prediction of early mortality on the waiting list for OLT. (10,11) Still, MELD-Na is prone to well-known limitations that comprise the lack of assessment of subclinical infection while on the waiting list and an underestimation of complications resulting from portal hypertension. (9,(12)(13)(14)(15) Accordingly, further optimization of the organ allocation process seems inevitable to reduce mortality before OLT.…”

mentioning

confidence: 99%

The von Willebrand Factor Facilitates Model for End‐Stage Liver Disease–Independent Risk Stratification on the Waiting List for Liver Transplantation

et al. 2020

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Background and Aims The Model for End‐Stage Liver Disease (MELD) is used for clinical decision‐making and organ allocation for orthotopic liver transplantation (OLT) and was previously upgraded through inclusion of serum sodium (Na) concentrations (MELD‐Na). However, MELD‐Na may underestimate complications arising from portal hypertension or infection. The von Willebrand factor (vWF) antigen (vWF‐Ag) correlates with portal pressure and seems capable of predicting complications in patients with cirrhosis. Accordingly, this study aimed to evaluate vWF‐Ag as an adjunct surrogate marker for risk stratification on the waiting list for OLT. Approach and Results Hence, WF‐Ag at time of listing was assessed in patients listed for OLT. Clinical characteristics, MELD‐Na, and mortality on the waiting list were recorded. Prediction of 3‐month waiting‐list survival was assessed by receiver operating characteristics and net reclassification improvement. Interestingly, patients dying within 3 months on the waiting list displayed elevated levels of vWF‐Ag (P < 0.001). MELD‐Na and vWF‐Ag were comparable and independent in their predictive potential for 3‐month mortality on the waiting list (area under the curve [AUC], vWF‐Ag = 0.739; MELD‐Na = 0.764). Importantly, a vWF‐Ag cutoff at 413% identified patients at risk for death within 3 months of listing with a higher odds ratio (OR) than the previously published cutoff at a MELD‐Na of 20 points (vWF‐Ag, OR = 10.873, 95% confidence interval [CI], 3.160, 36.084; MELD‐Na, OR = 7.594, 95% CI, 2.578, 22.372; P < 0.001, respectively). Ultimately, inclusion of vWF‐Ag into the MELD‐Na equation significantly improved prediction of 3‐month waiting‐list mortality (AUC, MELD‐Na–vWF = 0.804). Conclusions A single measurement of vWF‐Ag at listing for OLT predicts early mortality. Combining vWF‐Ag levels with MELD‐Na improves risk stratification and may help to prioritize organ allocation to decrease waiting‐list mortality.

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Resistive Index and MELD-Na: Nephrologic Monitoring in Cirrhotic Patients Awaiting Liver Transplantation

Cited by 7 publications

References 41 publications

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

Doppler assessment of splanchnic arterial flow in patients with liver cirrhosis: Correlation with ammonia plasma levels and MELD score

The von Willebrand Factor Facilitates Model for End‐Stage Liver Disease–Independent Risk Stratification on the Waiting List for Liver Transplantation

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