MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort

BackgroundVariceal bleeding is one of the most serious complications of cirrhosis. Up to now different methods are created for predicting the complications and mortality of cirrhosis. Child- Pugh score and MELD score are two methods for this use. In this study we investigated and compared survival prognosis of cirrhotic patients by the Child-Pugh or MELD score in two groups of esophageal and gastric variceal bleeding.Materials and MethodsIn this cross-sectional trial, patients with upper GI bleeding were followed up for a 6 months period. The source of hemorrhage was determined by endoscopy, then patients distributed in two groups of esophageal and gastric variceal hemorrhage. Finally we investigated and compared the relationship between the variables and mortality rates in these two groups by means of the Child-Pugh and the MELD scores. The Student's t-test and Receiver Operating Characteristic were used for statistical analysis.Results34 patients (12 with gastric varices, 22 with esophageal varices) were investigated. No significant difference between these two groups was observed. In this study mean MELD score was 16.67±8.75 and mean Child-Pugh score was 9.37±2.54. Eight patients (5 with gastric varices and 3 with esophageal varices) expired before 6 weeks and 2 patients (one four each group) expired after 6 weeks. The best cut-off points are 15.5 and 10.5 for MELD and Child-Pugh scores respectively (sensitivity and specificity are 0.75 and 0.98, respectively for both scores).ConclusionSensitivity and specificity of both scores were the same in prediction of mortality. However, the chance ratio defined that Child-Pugh score was a better predictor of mortality than MELD score, since the chance of death will increase 2.51 and 1.62 fold per each unit increase in the Child-Pugh and the MELD scores, respectively. However, no significant difference found between Child-Pugh and MELD score between two groups of patients.

Download Full-text

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

BioMed Research International ◽

10.1155/2020/7170457 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Si-Hai Chen ◽

Qin-Si Wan ◽

Ting Wang ◽

Kun-He Zhang

Keyword(s):

Liver Cirrhosis ◽

Venous Pressure ◽

Meld Score ◽

Careful Evaluation ◽

Risk Of Mortality ◽

Prediction Of Survival ◽

Prognosis Of Liver Cirrhosis ◽

Cirrhotic Patients ◽

End Stage ◽

Prognostic Functions

Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

Download Full-text

External validation of nomograms for prediction of survival outcome in retroperitoneal sarcoma using the North East England patient cohort

10.31487/j.cor.2018.03.106 ◽

2018 ◽

Author(s):

George Watkinson

Keyword(s):

External Validation ◽

Survival Outcome ◽

Retroperitoneal Sarcoma ◽

Patient Cohort ◽

North East ◽

The North ◽

Prediction Of Survival

Download Full-text

MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation

Gut ◽

10.1136/gut.2006.102764 ◽

2007 ◽

Vol 56 (9) ◽

pp. 1283-1290 ◽

Cited By ~ 128

Author(s):

M.-C. Londono ◽

A. Cardenas ◽

M. Guevara ◽

L. Quinto ◽

D. d. l. Heras ◽

...

Keyword(s):

Liver Transplantation ◽

Serum Sodium ◽

Meld Score ◽

Prediction Of Survival

Download Full-text

Predictive factors of failure to control bleeding and 6-week mortality after variceal hemorrhage in liver cirrhosis – a tertiary referral center experience

Archives of Medical Science ◽

10.5114/aoms/97206 ◽

2021 ◽

Author(s):

Daniela Matei ◽

Dana Crisan ◽

Bogdan Procopet ◽

Ioana Groza ◽

Bogdan Furnea ◽

...

Keyword(s):

Prognostic Factors ◽

Creatinine Level ◽

Predictive Factors ◽

Variceal Bleeding ◽

Meld Score ◽

Charlson Index ◽

Variceal Hemorrhage ◽

Tertiary Referral Center ◽

Factors Associated ◽

Child Class

IntroductionMortality from variceal bleeding remains high despite the therapeutic progress in severe cirrhosis. Understanding the predictive factors of failure to control bleeding (FTB) and mortality will lead to better future therapies. Comorbidities are thought to be important prognostic factors for variceal bleeding. The aim of the study was to assess the factors associated with FTB and with 42-day mortality and to evaluate the influence of comorbidities on these patients’ prognosis.Material and methodsWe prospectively included in the study all consecutive patients with cirrhosis and variceal bleeding presenting to the emergency room and we followed them up over 6 weeks. CirCom score and Charlson index were used for the assessment of comorbidities.ResultsOf the 138 patients included in the study, 27 (19.5%) were considered to have FTB. Child C class (74.07% vs. 32.43%, p < 0.001), Meld score (20.5 vs. 16.00, p = 0.004) and creatinine level (1.04 vs. 0.81, p = 0.01) were associated with FTB, but only Child class was independently associated with FTB in multivariate analysis (OR = 2.94, p = 0.006). Mortality at 42 days (21.7%) was influenced by the severity of the disease assessed through Child class (76.66% vs. 30.55% – Child C, p < 0.001) and MELD score (21.00 vs. 16.00, p < 0.001). Creatinine level (1.00 vs. 0.7, p = 0.02) and acute kidney injury (26.66% vs. 7.40%, p = 0.009) were also prognostic factors for the 6-week mortality. Comorbidities did not influence the mortality (CirCom > 1 (16.7% vs. 21.3%, p = 0.76) or Charlson index > 4 (36% vs. 47.2%, p = 0.41).ConclusionsThe severity of cirrhosis is an important prognostic factor for FTB and 42-day mortality. Identifying the factors associated with early mortality may help selecting patients needing more than conventional therapy.

Download Full-text

Child-Turcotte-Pugh and Model for End-Stage Liver Disease Scores: Accuracy of Predictability for Mortality in Acute Variceal Hemorrhage

Life and Science ◽

10.37185/lns.1.1.133 ◽

2021 ◽

Vol 2 (1) ◽

pp. 8

Author(s):

Kazim Abbas Virk ◽

Sana Tahir Virk ◽

Inayt Adil ◽

Shiza Tahir Virk ◽

Haseeb Noor ◽

...

Keyword(s):

Liver Disease ◽

Diagnostic Accuracy ◽

Positive Likelihood Ratio ◽

Mean Value ◽

Meld Score ◽

Variceal Hemorrhage ◽

End Stage Liver Disease ◽

The Mean ◽

Ctp Score ◽

End Stage

Objective: To determine a score that best predicts the mortality of admitted patients within six weeks of Acute Variceal Hemorrhage (AVH).Study Design: Cross sectional study.Place and Duration of Study: The study was conducted at Inpatient Department of Gastroenterology Unit at Pakistan Institute of Medical Sciences (PIMS), Islamabad for six months.Materials and Methods: The number of patients with AVH enrolled in this study were 223. A pretested questionnaire was used to gather the required information; Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of each patient were recorded at the time of admission in the inpatient facility. The outcome was documented via a telephonic call at the end of six weeks. The primary outcome of the study was “mortality” at end of six weeks.Results: The total number of participants were 223, including 61% (n=136) males and 39% (n=87) females. The mean age was 52.4±13.96. The overall mean value of CTP score was 9.6±2.8 and mean value of MELD score was 19.3±6.7, while the mean values of CTP and MELD among non-survivors were 12.9±2.1 and 26.6±5.6, respectively. After six weeks, the number of deaths were 27% (n=60). The MELD had positive predictive value (PPV) of 83.3%, negative predictive value (NPV) of 96.8%, sensitivity: 91.7%, specificity: 93.3%, diagnostic accuracy: 92.82%, and positive likelihood ratio of 13.68. Similarly, CTP had PPV: 77.4%, NPV: 92.5%, sensitivity: 80%, specificity: 91.4%, diagnostic accuracy: 88.34% and positive likelihood ratio of 9.3. The area under the curve (AUC)for MELD was 0.91, while CTP was 0.90.Conclusion: The MELD score is better in its discriminative ability and more accurate in predicting six weeks mortality in patients with AVH than CTP score.

Download Full-text