Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis

Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding. Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score. Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.

Download Full-text

Prognostic and Predictive Values of Meld Score , Platelet Count and Pre Albumin in Patients with Compensated and Decompensated Liver Cirrhosis with Acute Variceal Bleeding

Journal of the Egyptian Society of Parasitology ◽

10.12816/0006330 ◽

2012 ◽

Vol 42 (2) ◽

pp. 443-452 ◽

Cited By ~ 1

Author(s):

Sabry Abdel Fattah ◽

Naser Kamal El-Hamshary ◽

Yasser Fouad Kilany

Keyword(s):

Liver Cirrhosis ◽

Platelet Count ◽

Variceal Bleeding ◽

Meld Score ◽

Decompensated Liver Cirrhosis ◽

Predictive Values ◽

Acute Variceal Bleeding

Download Full-text

Prognostic factors for mortality in pediatric acute poststreptococcal glomerulonephritis

Paediatrica Indonesiana ◽

10.14238/pi56.3.2016.166-70 ◽

2016 ◽

Vol 56 (3) ◽

pp. 166

Author(s):

Syamsul Nur ◽

Husein Albar ◽

Dasril Daud

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Study Data ◽

High Serum ◽

Independent Prognostic Factor ◽

Poststreptococcal Glomerulonephritis ◽

Factors Affecting

Background Acute post-streptococcal glomerulonephritis (APSGN) is one of the most common causes of glomerular disease in developing countries, including Indonesia. It can lead to end stage renal failure and higher mortality rates. To decrease morbidity and mortality, it is important to understand the prognostic factors affecting the disease.Objective To identify prognostic factors affecting outcomes in pediatric APSGN patients.Methods Study data were collected from medical records of patients with APSGN hospitalized in Wahidin Sudirohusodo Hospital, Makassar in 2009-2013. Possible prognotic factors analyzed were gender, age, nutritional status, level of consciousness, as well as proteinuria, hemoglobin, serum albumin, urea, and creatinine levels.Results Of 86 subjects, 82 (95.3%) survived and 4 (4.7%) died. Fifty-three (61.6%) patients were male and 33 (38.4%) were female. Subjects’ ages ranged from 3.42 to 14.67 years, with a mean age of 9.36 years. Multivariate analysis revealed serum creatinine level >1.5 mg/dL to be an independent prognostic factor for mortality in children with APSGN (AOR 15.43; 95%CI 1.31 to 181.7; P=0.03).Conclusion High serum creatinine level is an independent prognostic factor for poor outcomes in children with APSGN. [Paediatr Indones. 2016;56:166-70.].

Download Full-text

Renal cortical retention of contrast medium on delayed CT and nephropathy following transcatheter arterial chemoembolisation in patients with high serum creatinine level

British Journal of Radiology ◽

10.1259/bjr.75.899.750874 ◽

2002 ◽

Vol 75 (899) ◽

pp. 874-878 ◽

Cited By ~ 7

Author(s):

H Yamazaki ◽

H Oi ◽

M Matshushita ◽

T Inoue ◽

H Nakamura ◽

...

Keyword(s):

Serum Creatinine ◽

Serum Creatinine Level ◽

Contrast Medium ◽

Creatinine Level ◽

High Serum ◽

Transcatheter Arterial Chemoembolisation

Download Full-text

Serum creatinine level is not appropriate in predicting prognosis in patients with liver cirrhosis and sarcopenia

Journal of Hepatology ◽

10.1016/s0168-8278(17)31089-9 ◽

2017 ◽

Vol 66 (1) ◽

pp. S372

Author(s):

H.A. Lee ◽

Y.S. Seo ◽

Y.K. Jung ◽

J.H. Kim ◽

H.J. Yim ◽

...

Keyword(s):

Liver Cirrhosis ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level

Download Full-text

Faculty Opinions recommendation of Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726775017.793523611 ◽

2016 ◽

Author(s):

Bruce Bistrian

Keyword(s):

Serum Creatinine ◽

Serum Creatinine Level ◽

Critically Ill ◽

Creatinine Level ◽

Muscle Mass ◽

Critically Ill Patients

Download Full-text

Performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding

Egyptian Liver Journal ◽

10.1186/s43066-021-00088-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Rehab Elsayed Elsafty ◽

Abdallah Ahmed Elsawy ◽

Ahmed Fawzy Selim ◽

Atef Mohamed Taha

Keyword(s):

Hepatic Encephalopathy ◽

Variceal Bleeding ◽

Early Discharge ◽

Meld Score ◽

Bleeding Control ◽

Acute Variceal Bleeding ◽

Prophylactic Measures ◽

Significant Performance ◽

Cirrhotic Patients ◽

Grade 3

Abstract Background Hepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, particularly those are admitted by acute variceal bleeding. We evaluated the performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores. This prospective cohort study was conducted on 250 cirrhotic patients who were consecutively presented by acute variceal bleeding in the period from January to December 2020 at Tanta university emergency hospital. Albumin-bilirubin, Child-Pugh, and MELD scores were measured at admission, and then all patients were followed up for 4 weeks after endoscopic bleeding control for possible occurrence of hepatic encephalopathy Results Albumin-bilirubin, Child-Pugh, and MELD scores had significant performances in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding; in this regard, albumin-bilirubin score had the highest accuracy (AUC 0.858, CI 0.802-0.914, sig 0.000) followed by Child-Pugh score (AUC 0.654, CI 0.574–0.735, sig 0.001) and then MELD score (AUC 0.602, CI 0.519–0.686, sig 0.031). The cumulative incidence of hepatic encephalopathy in cirrhotic patients with albumin-bilirubin grade 3 was found to be significantly more than that present in albumin-bilirubin grade 2; most of these hepatic encephalopathy cases occurred in the first 2 weeks of follow-up period. Conclusions Albumin-bilirubin score has a significant performance in risk prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding better than Child-Pugh and MELD scores. Albumin-bilirubin grades could be used as a risk stratifying tool to triage cirrhotic patients who will benefit from early discharge after bleeding control and those patients who will benefit from prophylactic measures for hepatic encephalopathy.

Download Full-text

Pathogenesis and Assessment of Renal Function in Patients With Liver Cirrhosis

Folia Medica ◽

10.2478/v10153-011-0100-z ◽

2012 ◽

Vol 54 (4) ◽

pp. 5-13 ◽

Cited By ~ 5

Author(s):

Bilyana H. Teneva

Keyword(s):

Renal Function ◽

Liver Cirrhosis ◽

Glomerular Filtration Rate ◽

Serum Creatinine ◽

Glomerular Filtration ◽

Filtration Rate ◽

Serum Markers ◽

Meld Score ◽

Kidney Damage ◽

Early Assessment

Abstract In liver cirrhosis patients awaiting liver transplantation, it is prognostically equally important to assess the renal function before and after transplantation. This is evidenced by the inclusion of serum creatinine in the Model for End-Stage Liver Disease (MELD) score. Most of the causes of renal failure in liver cirrhosis are functional, the acute kidney damage including prerenal azotemia, acute tubular necrosis and hepatorenal syndrome. A major index of the renal function, the glomerular filtration rate (GFR) is determined in a specific way in patients with liver cirrhosis. Clinically, serum creatinine is considered the best indicator of kidney function, although it is rather unreliable when it comes to early assessment of renal dysfunction. Most of the patients with liver cirrhosis have several concomitant conditions, which are the reason for the false low creatinine levels, even in the presence of moderate to severe kidney damage. This also holds for the creatinine clearance and creatinine-based estimation equations for assessment of the glomerular filtration rate (the Cockroft-Gault and MDRD formulas), which overestimate the real glomerular filtration. Clearance of exogenous markers is considered a gold standard, but the methods for their determination are rather costly and hard to apply. Alternative serum markers (e.g., cystatin C) have been used, but they should be better studied in cases of liver cirrhosis assessment.

Download Full-text