Child-Pugh Score for Mortality in Cirrhosis

2017 ◽  
Author(s):  
Rachel J. Kwon
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Intervention ◽  
Meld Score ◽  
Historical Study ◽  
Evidence Based ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage ◽  
Based Medicine ◽  
Objective Tool

This chapter provides a summary of a landmark historical study in surgery deriving the Child-Pugh score for mortality in cirrhosis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: prognosis studies. There is a critical need for prognostic tools for selecting appropriate patients with liver cirrhosis and portal hypertension for surgical intervention. The development of the Child-Pugh score, and now the Model for End-Stage Liver Disease (MELD) score, has provided surgeons with an evidence-based objective tool for informing these decisions.

Acute Appendicitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Acute Appendicitis ◽  
Study Design ◽  
Observational Studies ◽  
Surgical Intervention ◽  
Case Series ◽  
Historical Study ◽  
Evidence Based ◽  
Broad Spectrum Antibiotic ◽  
History Of ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in surgery involving management and treatment of acute appendicitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: observational studies in study design. Reginald H. Fitz’s insights over a century ago in a seminal case series regarding the nature of appendicitis, its potential sequelae, and the value of urgent surgical intervention changed the disease from a deadly one into one that can be easily cured by surgery. However, with the advent of modern broad spectrum antibiotic therapy, Fitz’s assertion that immediate surgical therapy is always mandated has recently come under question.

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

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.

Internal Mammary Artery Ligation versus Sham Sternotomy for Angina Pectoris

2017 ◽  
Author(s):  
Michael P. Catanzaro
Keyword(s):  
Angina Pectoris ◽  
Internal Mammary Artery ◽  
Historical Study ◽  
Evidence Based ◽  
Artery Ligation ◽  
Sham Surgery ◽  
Internal Mammary ◽  
History Of ◽  
Clinical Questions ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in cardiac surgery related to internal mammary artery ligation versus sham sternotomy for angina pectoris. It describes the history of the procedure and a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: blinding and sham surgery. Whether or not sham surgery is ethical remains under debate. Proponents for sham surgery agree that it should be used only when a question cannot be answered adequately by other methods. Cobb and his colleagues were among the first to demonstrate the value of sham studies in addressing important clinical questions.

scholarly journals Investigation of Bacteremia due toAeromonasSpecies and Comparison with That due to Enterobacteria in Patients with Liver Cirrhosis

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Toru Shizuma ◽  
Chiharu Tanaka ◽  
Hidezo Mori ◽  
Naoto Fukuyama
Keyword(s):  
Liver Cirrhosis ◽  
Japanese Patients ◽  
Meld Score ◽  
Short Term ◽  
E Coli ◽  
End Stage Liver Disease ◽  
Short Term Mortality ◽  
Clinical Background ◽  
End Stage

Background. The role ofAeromonasspecies (sp.) in bacteremia in Japanese patients with liver cirrhosis is poorly understood.Aim. To establish the importance ofAeromonassp. as a cause of bacteremia in patients with liver cirrhosis.Methods. Clinical and serological features and short-term prognosis were retrospectively investigated and compared in Japanese patients with bacteremia due toAeromonassp. () and due to enterobacteria (E. coli, Klebsiellasp., andEnterobactersp.) ().Results. There were no significant differences in patients’ clinical background, renal dysfunction, or short-term mortality rate between the two groups. However, in theAeromonasgroup, the model for end-stage liver disease (MELD) score and Child-Pugh score were significantly higher than in the enterobacteria group.Conclusion. These results indicate that the severity of liver dysfunction inAeromonas-induced bacteremia is greater than that in enterobacteria-induced bacteremia in Japanese patients with liver cirrhosis.

scholarly journals Mortality and its Determinants in Adult Patients with End-stage Liver Disease on Waiting List for Liver Transplantation: A Preliminary Report on Baseline Data

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kamran Bagheri Lankarani ◽  
Behnam Honarvar ◽  
Mohammad Reza Rouhezamin ◽  
Hadi Raeisi Shahraki ◽  
Vahid Seifi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Weight Loss ◽  
Liver Disease ◽  
Gallbladder Wall ◽  
Meld Score ◽  
Organ Allocation ◽  
Ca 125 ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage

Background: Prevention of death in patients on the waiting list for liver transplantation (LT) is a major concern to prioritize organ allocation. Since the model for the end-stage liver disease (MELD) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. Objectives: The current study aimed at assessing the predictors of mortality in LT candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. Methods: In the current cohort study, 544 adult LT candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. Data analysis was performed in Nutritionist, SPSS, and R software, using Kaplan-Meier, Cox proportional hazard (HRC), and LASSO Cox regression hazard (HRL) tests. Results: The mean age of the patients was 46.7 ± 13.7 years; the majority were male (n = 336, 61.7%). At the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. The cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. Although there was a strong association between having hepatopulmonary syndrome (HPS) (HRC = 4.7, HRL = 1.8), a history of myocardial infarction (MI) (HRC = 3.3, HRL = 1.6), low-carbohydrate (CHO) diet (HRC = 2.7, HRL = 1.5), and mortality, it was weak for MELD score. Moreover, a serum level of CA 125, high polymorphonuclear (PMN) count, weight loss, a high level of alanine aminotransferase (ALT), positive hepatitis B virus (HBV) markers, high mean corpuscular volume (MCV) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in LT patients. Conclusions: In addition to MELD score, HPS, a history of MI, low CHO intake, weight loss, ascites, PMN, CA 125, ALT, hepatitis B surface antigen, MCV, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in LT candidates and need to be considered in the LT allocation system.

Timing of Cholecystectomy after Biliary Pancreatitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Hospital Admission ◽  
Randomized Study ◽  
Historical Study ◽  
Evidence Based ◽  
Biliary Pancreatitis ◽  
Increased Risk ◽  
History Of ◽  
Timing Of Cholecystectomy ◽  
Based Medicine ◽  
Current Guidelines

This chapter provides a summary of a landmark historical study in surgery related to timing of cholecystectomy after biliary pancreatitis. It describes the history of the disease, a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: systematic reviews. This study was the first prospective randomized study to show that early removal of impacted gallstones did not prevent the progression of pancreatitis but did put patients at increased risk for other complications. Current guidelines, informed by this and subsequent studies, recommend that surgery be performed after pancreatic inflammation has subsided but ideally during the same hospital admission.

A Study on Haematological Manifestations in Patients with Chronic Liver Disease in a Tertiary Care Hospital of North India

2021 ◽  
Vol 8 (25) ◽  
pp. 2222-2228
Author(s):  
Jasmine Kaur ◽  
Navjot Kaur ◽  
Jasleen Kaur ◽  
Navjot Kaur Layal ◽  
Gurkiran Kaur
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Prothrombin Time ◽  
Chronic Liver Disease ◽  
Tertiary Care ◽  
Meld Score ◽  
Chronic Liver ◽  
Care Hospital ◽  
End Stage Liver Disease ◽  
End Stage

BACKGROUND Chronic liver diseases frequently are associated with haematological abnormalities. Anaemia occurs in about 75% of patients with chronic liver disease. The most common type of anaemia seen in liver cirrhosis is normocytic normochromic anaemia, due to the chronic inflammatory state, blood loss from oesophageal and rectal varices. The purpose of this study was to study the haematological manifestations in patients with chronic liver disease. METHODS A cross-sectional observational study was conducted at Sri Guru Ram Das Institute of Medical Sciences and Research (March 2019 - March 2020). Total of 90 patients with chronic liver disease were included in the study. The population was divided into 2 groups based on the model for end-stage liver disease (MELD) score and the various haematological abnormalities were assessed in these 2 groups. Similarly, haemoglobin (Hb) levels were assessed in 3 groups based on the ChildTurcotte-Pugh (CTP) classification. RESULTS There was a significant correlation between hemoglobina and CTP class (P < 0.001), with the lowest haemoglobin levels in CTP class C group. The correlation coefficient of MELD score and haemoglobin was -0.504 which was significant statistically. Thus, confirming the fact that haemoglobin levels decreases with the progress in the severity of liver cirrhosis. Of 39 patients with haemoglobin < 8 g/dl, 5 (12.8 %) had a MELD score of < 12, whereas 34 patients (87.2 %) had a MELD score of > 12 and was statistically significant (P < 0.0001). Leukocytosis was observed in 41 patients and leucopoenia in 14 patients. The mean prothrombin time was 20.4 seconds and 80 % of the patients had prothrombin time prolonged by more than 6 sec indicating liver damage alters coagulation profile. CONCLUSIONS We found an association between anaemia and indicators of advanced liver disease such as a higher MELD and CPS scores. This study inferred that levels of haemoglobin decrease as the severity of liver disease progresses. Thus, this measure can be used in the initial assessment of cirrhosis patients that needs urgent identification and correction to reduce morbidity and mortality. KEYWORDS Anaemia, Liver Cirrhosis, Model for End-Stage Liver Disease Score, Child-TurcottePugh Class

Can the MELD Score Predict Perioperative Morbidity for Patients with Liver Cirrhosis Undergoing Laparoscopic Cholecystectomy?

2008 ◽  
Vol 74 (2) ◽  
pp. 156-159 ◽  
Author(s):  
Juliane Bingener ◽  
Diane Cox ◽  
Joel Michalek ◽  
Alejandro Mejia
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Laparoscopic Cholecystectomy ◽  
Significant Variation ◽  
Meld Score ◽  
Morbidity Rate ◽  
Perioperative Morbidity ◽  
End Stage Liver Disease ◽  
The Mean ◽  
End Stage

The Model for End Stage Liver Disease (MELD) score is a mortality predictor in patients awaiting liver transplantation. We evaluated the MELD score's ability to predict morbidity for patients with cirrhosis undergoing laparoscopic cholecystectomy. From March 1991 to February 2004, data of all patients undergoing laparoscopic cholecystectomy were prospectively collected. Data of patients with liver cirrhosis were reviewed. The MELD and Child scores were correlated with outcome variables. Of 7859 patients undergoing laparoscopic cholecystectomy, 99 patients (1.3%) exhibited liver cirrhosis, 44 women and 55 men. The mean age was 55 years (range, 28 to 92 years). The mortality rate was 6.3 per cent, morbidity rate 18 per cent, and conversion rate 11 per cent. Laboratory values on 55 patients were available to calculate MELD scores. The mean MELD score was 11 (range, 6 to 23). There was no significant variation in MELD scores with gender ( P = 0.61) or cirrhosis etiology, alcoholic and nonalcoholic ( P = 0.52). MELD and Child's score correlated well ( P < 0.001); however, the risk of complication was not related to the MELD ( P = 0.94) or Child-Pugh-Turcotte score ( P = 0.26). Morbidity for patients with liver cirrhosis undergoing laparoscopic cholecystectomy remains high. The MELD score is useful for transplant risk stratification for but requires further investigation regarding morbidity prediction for laparoscopic cholecystectomy.

scholarly journals Evaluation of Mortality Risk in Liver Cirrhosis with Albumin- Bilirubin (Albi), Platelet-Albumin-Bilirubin (Palbi), and Fibrosis-4 (Fib-4) Scores

2021 ◽  
Vol 14 (02) ◽  
pp. 985-991
Author(s):  
D.A. Sindhughosa ◽  
I.K. Mariadi ◽  
I.D.N. Wibawa ◽  
I.G.A. Suryadarma ◽  
N. Purwadi ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Mortality Risk ◽  
Liver Diseases ◽  
Cross Sectional Study ◽  
Meld Score ◽  
Sectional Study ◽  
Cross Sectional ◽  
End Stage Liver Disease ◽  
End Stage

Background:The model for end stage liver disease (MELD) score considered as a reliable predictor of survival for advanced liver diseases patients. Among several chemistry laboratorium examinations, albumin, bilirubin and platelet reflect the function of the liver. Objectives: To investigate the correlation of albumin-bilirubin (ALBI), platelet-albumin-bilirubin (PALBI), and fibrosis-4 (FIB-4) scores with mortality risk based on MELD score and evaluate their role in predictingcirrhosis mortality risk. Methods: The analytic cross-sectional study designrecruited adults with liver cirrhosis of any etiology during the period of November 2018 through January 2019. Descriptive and correlative analyses were done before proceeding to diagnostic abilityanalysis. Results: Sixty-two patients with mean age of 52.95 ± 12.05 were included in the analysis. The ALBI, PALBI, and FIB-4 scores were significantly correlated with higher mortality risk based on MELD score. The three scoressignificantly predicted higher mortality risk with varying sensitivity and specificity. Conclusion: Positivecorrelation between ALBI, PALBI, and FIB-4 scores with MELD score was found. ALBI (≥-1.26), PALBI (≥-2.05), and FIB-4 (≥5.84) values higher than the thresholdcould predict mortality risk in cirrhosis.

scholarly journals Correlation of aspartate aminotransferase-to-platelet ratio index with child-turcotte-Pugh score and model for end stage liver disease score in patients of liver cirrhosis

2021 ◽  
Author(s):  
Princi Jain ◽  
Yatish Agarwal ◽  
Bijender Kumar Tripathi ◽  
Anil Kumar Jain ◽  
Divesh Jalan ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Aspartate Aminotransferase ◽  
Pearson Correlation ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Normal Platelet ◽  
Severity Scores ◽  
Ctp Score ◽  
End Stage

Background: Though liver biopsy is considered to be a gold standard for the diagnosis and severity of liver cirrhosis, recently many non-invasive markers have come up for the same. In the current study, we investigated the correlation of aspartate aminotransferase-to-platelet ratio index with other severity scores of liver cirrhosis namely child-turcotte-Pugh score and model for end stage liver disease score.Methods: Fifty-one patients with cirrhosis, identified on the basis of abdomen ultrasonographic findings were enrolled in the study. APRI was calculated for every patient using the formula, (AST/upper limit of normal/platelet count;109/l)×100. The MELD score was calculated according to the original formula proposed by the Mayo clinic group: 3.8×loge (bilirubin; mg/dl)+11.2×loge(INR)+ 9.6×loge (creatinine; mg/dl)+6.4. CTP scoring was calculated based on the severity of hepatic encephalopathy, ascites, total bilirubin, albumin, and INR. Correlation of APRI with MELD and CTP score was established using Pearson correlation coefficient.Results: APRI scores correlated well with the severity of the cirrhosis. With the progression of the CTP class from A to C and with increase in the MELD score, increase in the APRI index was also observed.Conclusions: APRI showed positive correlation with CTP and MELD score.

Sign in / Sign up

Export Citation Format

Share Document