The model of end-stage liver disease (MELD) score in predicting postoperative liver failure after hepatic resection of hepatocellular carcinoma in cirrhotic patients: The Tunisian experience

Background: The albumin-bilirubin (ALBI) grade is a newly proposed model for assessing the hepatic function. This study aimed to compare the value of the ALBI score with Child-Pugh score, model for end-stage liver disease (MELD) score and indocyanine green (ICG) R15 in predicting posthepatectomy liver failure (PHLF). Methods: Patients undergoing curative resection for hepatocellular carcinoma (HCC) between January 2014 and June 2017 were enrolled. The values of the Child-Pugh score, MELD score, ICG R15 and ALBI score in predicting PHLF were evaluated. Results: A total of 473 HCC patients were enrolled. The ALBI score was identified as an independent predictor of PHLF. The AUCs for the Child-Pugh score, MELD score, ICG R15 and ALBI score in predicting PHLF were 0.665, 0.649, 0.668, and 0.745 respectively. Multivariable analyses revealed that the ALBI score was an independent predictor of PHLF regardless of the hepatectomy subgroups, but the Child-Pugh score and MELD score were not significant predictors of PHLF both in major and minor hepatectomy subgroups, and ICG R15 was only a significant predictor of PHLF in minor hepatectomy subgroup. Conclusion: The ALBI score showed superior predictive value of PHLF over Child-Pugh score, MELD score and ICG R15. We propose to use the ALBI score to evaluate surgical risk for HCC patients undergoing hepatic resection.

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Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00344-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Ahmed Abdelrahman Mohamed Baz ◽

Rana Magdy Mohamed ◽

Khaled Helmy El-kaffas

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Portal Vein ◽

Hepatic Artery ◽

Meld Score ◽

Hepatic Decompensation ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

Us Findings ◽

End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

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RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

Journal of Immunology Research ◽

10.1155/2018/1509851 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Zhenzhen Zhang ◽

Guomin Xie ◽

Li Liang ◽

Hui Liu ◽

Jing Pan ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Poor Prognosis ◽

Alcoholic Cirrhosis ◽

Normal Liver ◽

Neutrophil Infiltration ◽

Meld Score ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

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The use of MELD scores in critically ill cirrhotic patients

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v4i16.329 ◽

2016 ◽

Vol 4 (16) ◽

pp. 45

Author(s):

Supannee Rassameehiran ◽

Tinsay Woreta

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Hospital Mortality ◽

Organ Failure ◽

Critically Ill ◽

Meld Score ◽

Chronic Liver Failure ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

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Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients

Oncology ◽

10.1159/000502482 ◽

2020 ◽

Vol 98 (12) ◽

pp. 836-846

Author(s):

Reham Abdel-Wahab ◽

Manal M. Hassan ◽

Bhawana George ◽

Roberto Carmagnani Pestana ◽

Lianchun Xiao ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Growth Factor ◽

Meld Score ◽

Waiting List ◽

Survival Prediction ◽

Insulin Like Growth Factor ◽

Priority Assignment ◽

End Stage Liver Disease ◽

End Stage

Background: Liver reserve affects survival in hepatocellular carcinoma (HCC). Model for End-Stage Liver Disease (MELD) score is used to predict overall survival (OS) and to prioritize HCC patients on the transplantation waiting list, but more accurate models are needed. We hypothesized that integrating insulin-like growth factor 1 (IGF-1) levels into MELD score (MELD-IGF-1) improves OS prediction as compared to MELD. Methods: We measured plasma IGF-1 levels in training (n = 310) and validation (n = 155) HCC cohorts and created MELD-IGF-1 score. Cox models were used to determine the association of MELD and MELD-IGF-1 with OS. Harrell’s c-index was used to compare the predictive capacity. Results: IGF-1 was significantly associated with OS in both cohorts. Patients with an IGF-1 level of ≤26 ng/mL in the training cohort and in the validation cohorts had significantly higher hazard ratios than patients with the same MELD but IGF-1 >26 ng/mL. In both cohorts, MELD-IGF-1 scores had higher c-indices (0.60 and 0.66) than MELD scores (0.58 and 0.60) (p < 0.001 in both cohorts). Overall, 26% of training and 52.9% of validation cohort patients were reclassified into different risk groups by MELD-IGF-1 (p < 0.001). Conclusions: After independent validation, the MELD-IGF-1 could be used to risk-stratify patients in clinical trials and for priority assignment for patients on liver transplantation waiting list.

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