The Risk Of Surgery In Patients With Liver Disease 2

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Disease Patient ◽  
Case Series ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Ctp Score ◽  
End Stage

The results of retrospective largescale registry and cohort studies and small case series, substantiate the common perception that operating on a liver disease patient is risky. The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially but not exclusively in cirrhotics. The risks of operating on patients with non-cirrhotic liver disease are reviewed with particular emphasis on the poor outcomes in acute hepatitis—especially alcoholic hepatitis—severe fatty liver disease, and obstructive jaundice. The outcomes of a broad spectrum of surgical procedures in cirrhotics (abdominal, cardiothoracic, orthopedic, vascular, etc.) are reviewed, with particular reference to common predictors of survival and morbidity, such as the Child-Turcotte-Pugh (CTP) score/class and the model for end-stage liver disease (MELD) score. The concept is proposed that the height of portal pressure may be a predictive factor of surgical outcome, which derives from experience with hepatic resection and suggests that measurement of hepatic venous pressures may be worthwhile in selected cases. New, non-invasive estimates of liver function are presented. A simple practical pre-operative decision tree is provided. This review contains 5 figures, 3 tables and 91 references Keywords: cirrhosis, fatty liver, hepatic venous pressure gradient, hepatitis, model for end-stage liver disease, operative mortality, portal hypertension, Child-Turcotte-Pugh  

The Risk Of Surgery In Patients With Liver Disease 2

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Disease Patient ◽  
Case Series ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Ctp Score ◽  
End Stage

The results of retrospective largescale registry and cohort studies and small case series, substantiate the common perception that operating on a liver disease patient is risky. The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially but not exclusively in cirrhotics. The risks of operating on patients with non-cirrhotic liver disease are reviewed with particular emphasis on the poor outcomes in acute hepatitis—especially alcoholic hepatitis—severe fatty liver disease, and obstructive jaundice. The outcomes of a broad spectrum of surgical procedures in cirrhotics (abdominal, cardiothoracic, orthopedic, vascular, etc.) are reviewed, with particular reference to common predictors of survival and morbidity, such as the Child-Turcotte-Pugh (CTP) score/class and the model for end-stage liver disease (MELD) score. The concept is proposed that the height of portal pressure may be a predictive factor of surgical outcome, which derives from experience with hepatic resection and suggests that measurement of hepatic venous pressures may be worthwhile in selected cases. New, non-invasive estimates of liver function are presented. A simple practical pre-operative decision tree is provided. This review contains 5 figures, 3 tables and 91 references Keywords: cirrhosis, fatty liver, hepatic venous pressure gradient, hepatitis, model for end-stage liver disease, operative mortality, portal hypertension, Child-Turcotte-Pugh  

scholarly journals Application of Hepatic Venous Pressure Gradient to Predict Prognosis in Cirrhotic Patients with a Low Model for End-stage Liver Disease Score

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 805
Author(s):  
Young Chang ◽  
Ki Tae Suk ◽  
Soung Won Jeong ◽  
Jeong-Ju Yoo ◽  
Sang Gyune Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Disease ◽  
Predictive Power ◽  
Venous Pressure ◽  
Meld Score ◽  
Time Dependent ◽  
Viral Etiology ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Background/aim: We aimed to derive a model representing the dynamic status of cirrhosis and to discriminate patients with poor prognosis even if the Model for End-Stage Liver Disease (MELD) score is low. Methods: This study retrospectively enrolled 700 cirrhotic patients with a MELD score of less than 20 who underwent hepatic venous pressure gradient (HVPG) measurement. A model named H6C score (= HVPG + 6 × CTP score) to predict overall survival was derived and internal and external validations were conducted with the derivation and validation cohorts. Results: The H6C score using the HVPG was developed based on a multivariate Cox regression analysis. The H6C score showed a great predictive power for overall survival with a time-dependent AUC of 0.733, which was superior to that of a MELD of 0.602. In patients with viral etiology, the performance of the H6C score was much improved with a time-dependent AUC of 0.850 and was consistently superior to that of the MELD (0.748). Patients with an H6C score below 45 demonstrated an excellent overall survival with a 5-year survival rate of 91.5%. Whereas, patients with an H6C score above 64 showed a dismal prognosis with a 5-year survival rate of 51.1%. The performance of the H6C score was further verified to be excellent in the validation cohort. Conclusion: This new model using the HVPG provides an excellent predictive power in cirrhotic patients, especially with viral etiology. In patients with H6C above 64, it would be wise to consider early liver transplantation to positively impact long-term survival, even when the MELD score is low.

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.

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

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.

scholarly journals Creatinine-modified Child-Turcotte-Pugh score is a good predictor of a short-term survival in patients with bleeding from esophageal varices

2017 ◽  
Vol 74 (1) ◽  
pp. 13-18
Author(s):  
Mirjana Radisavljevic ◽  
Goran Bjelakovic ◽  
Jasna Jovic ◽  
Biljana Radovanovic-Dinic ◽  
Danijela Benedeto-Stojanov ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Esophageal Varices ◽  
Meld Score ◽  
Prognostic Scores ◽  
Short Term ◽  
End Stage Liver Disease ◽  
Ctp Score ◽  
End Stage

Background/Aim. Bleeding from esophageal varices is a significant factor in mortality of patients with terminal liver cirrhosis. This complication is a major health problem for recipients on the list for liver transplant. In that regard, studying predictors of variceal bleeding episode is very important. Also, it is important to find the best survival predictor among prognostic scores. The aim of the study was to compare validity of prognostic scores in assessment of survival in hospital-treated patients after bleeding from esophageal varices, and to compare validity of baseline Child-Turcotte-Pugh (CTP) and Modul for End-stage Liver Disease (MELD) scores with CTP creatinine modified (CTP-crea) I and II scores in assessment of survival in patients within a long-term follow-up period after the episode of bleeding from esophageal varices. Methods. The study included a total of 126 patients suffering from terminal liver cirrhosis submited to testing CTP score score I and II, MELD score, MELD Na score, integrated MELD score, MELD sodium (MESO) index, United Kingdom Model for End-Stage Liver Disease (UKELD) score and updated MELD score. Results. Patients with bleeding from esophageal varices most often had CTP score rank C (46,9%). CTP score rank B had 37.5% patients, while the smallest percentage of patients had CTP rank A, 15.6% of them. Patients who have values of CTP score higher than 10.50 and bleeding from esophagus, have 3.2 times higher chance for death outcome compared to other patients. Patients who have values of CTP-crea I score higher than 10.50 and bleeding from esophagus, have 3.1 times higher chance for death out-come than other patients. Patients who have values of CTP-crea II score higher than 11.50 and bleeding from esophagus, have 3,7 times higher chance for death outcome compared to other patients. Conclusion. Survival of patients with bleeding from esophageal varices in the short-term follow up can be predicted by following CTP score and creatinine modified CTP scores. Patients with bleeding from esophageal varices who have CTP score and CTP-crea I score higher than 10.5 and CTP-crea II score higher than 11.5, have statistically significantly higher risk from mortality within one-month follow-up compared to patients with bleeding from esophageal varices who have lower numerical values of scores of the CTP group.

scholarly journals COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324879
Author(s):  
Luca Saverio Belli ◽  
Christophe Duvoux ◽  
Paolo Angelo Cortesi ◽  
Rita Facchetti ◽  
Speranta Iacob ◽  
...  
Keyword(s):  
Liver Disease ◽  
Respiratory Failure ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
End Stage Liver Disease ◽  
Significant Difference ◽  
End Stage ◽  
The Impact

ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

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.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
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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