PROGNOSTIC VALUE OF COMBINATION AIMS65 AND MELD SCORES IN CIRRHOTIC PATIENTS WITH ACUTE VARICEAL BLEEDING

2019 ◽  
pp. 35-40
Author(s):  
Thi Nhung Nguyen ◽  
Trung Nam Phan ◽  
Van Huy Tran
Keyword(s):  
Clinical Practice ◽  
Portal Hypertension ◽  
Key Words ◽  
Variceal Bleeding ◽  
Prognostic Value ◽  
High Rate ◽  
Central Hospital ◽  
Acute Variceal Bleeding ◽  
Cirrhotic Patients ◽  
Sensitivity Specificity

Bacground: Variceal bleeding is a severe complication of portal hypertension due to cirrhosis with high rate of motality, hence, predicting early rebleeding and mortality in cirrhotic patients with acute variceal bleeding is vital in clinical practice. Objectives: To evaluate the prognostic value of the combination of AIMS65 and MELD scores in predicting first 5 days in-hospital rebleeding and mortality in cirrhotic patients with acute variceal bleeding. Materials and Methods: 44 cirrhotic patients with acute variceal bleeding hospitalized at Hue Central Hospital. MELD and AIMS65 scores were calculated within the first 24 hours and monitoring rebleeding and mortality in the first 5 days in these patients. Results: AIMS65, MELD scores can predict first 5 days rebleeding and mortality with AUROC are 0.81, 0.69 and 0.92, 0.95, respectively. Combination of AIMS65 and MELD scores can predict first 5 days in hospital rebleeding with AUROC is 0.84, sensitivity 83.3%, specificity 81.6% (p<0.001) and mortality with AUROC is 0.96, sensitivity 100%, specificity 92.7% (p<0.001). Conclusions: The combination of AIMS65 and MELD scores increased the sensitivity, specificity and prognostic value in predicting first 5 days in-hospital rebleeding and mortality in cirrhotic patients with acute variceal bleeding in compare to each single scores. Key words: AiMS65 score, MELd, acute variceal bleeding

PROGNOSTIC VALUE OF MELD SCORE IN CHILD PUGH C CIRRHOTIC PATIENTS

2019 ◽  
pp. 67-73
Author(s):  
Thi Minh Duc Vo ◽  
Stackhouse Frank A. ◽  
Van Huy Tran
Keyword(s):  
Variceal Bleeding ◽  
Prognostic Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Prognostic Score ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Bacterial Peritonitis ◽  
Acute Variceal Bleeding ◽  
Cirrhotic Patients

Background and aims: The Model for End Stage Liver Disease (MELD) is a scoring system used for the prioritization of patients waiting for liver transplantation. Patients with decompensated cirrhosis often have serious complications. The aims of this study were to evaluate the prognostic value of MELD score in relation to mortality complications and to acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy, hepatorenal syndrome of Child Pugh C Vietnamese cirrhotic patients in a period of six months after hospitalization. Methods: This prospective study includes 102 consecutive Child Pugh C cirrhotic patients who were admitted to the Gastrointestinal Department of Hue Central Hospital and the General Internal Medicine Department of Hue University of Medicine and Pharmacy Hospital, Vietnam, from April 2016 to February 2017. The MELD score of each patient was calculated at admission. All patients were then observed for 6 months to assess the following: acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy, hepatorenal syndrome and mortality. Results: The mean MELD score of all patients was 19.5 ± 7.1; of male patients was 19.7 ± 7.4; of female patients was 18.43 ± 4.4; of alcoholic patients was 19.5 ±7.5; and of non – alcoholic patients was 19.6 ± 5.9. The MELD score correlated with mortality during 6 months after hospitalization (with cut – off = 20; AUC = 0,69; sensitivity and specificity were 56.0% and 76.6%) and with hepatorenal syndrome (with cut – off = 25; AUC = 0.90; sensitivity = 83.3% and specificity = 85.4%). In this study, the MELD score did not correlated acute variceal bleeding, spontaneous bacterial peritonitis, hepatoencephalopathy during 6 months after hospitalization. Conclusion: MELD is a valuable prognostic score for mortality and hepatorenal syndrome in Child Pugh C cirrhotic patients in 6 months after hospitalization. Key words: MELD score, Child Pugh C cirrhotic patients

PROGNOSTIC VALUE OF MELD SCORE IN CHILD PUGH C CIRRHOTIC PATIENTS

2017 ◽  
pp. 119-125
Author(s):  
Thi Minh Duc Vo ◽  
Van Huy Tran ◽  
Trong Thang Hoang
Keyword(s):  
Sensitivity And Specificity ◽  
Variceal Bleeding ◽  
Prognostic Value ◽  
Hepatorenal Syndrome ◽  
Meld Score ◽  
University Hospital ◽  
Prognostic System ◽  
General Internal ◽  
Acute Variceal Bleeding ◽  
Cirrhotic Patients

Background and aims: Model for End Stage Liver Disease (MELD) is a scoring system used for prioritization of patients waiting liver transplantation. Patients with decompensated cirrhosisoftenshave serious complications. The aims of this study was to evaluate prognostic value of MELD score for complications (mortality, acute variceal bleeding, spontaneous bacteremia peritonitis, hepatoencephalopathy, hepatorenal syndrome) of Child Pugh C cirrhotic patients in 6 months after hospitalizing. Methods: This prospective study included 102 consecutive Child Pugh C cirrhotic patients who were admitted in the period april 2016 to February 2017 in the Gastrointestinal Department, Hue Central Hospital and the General Internal Medicine Department, Hue University Hospital. At admission the MELD score of each patient was calculated. All patients were followed up for 6 months to assess the events: mortality, acute variceal bleeding, spontaneous bacteremia peritonitis, hepatoencephalopathy, hepatorenal syndrome. Results: Mean MELD score of all patients was 19.5 ± 7.1; of male patients was 19.7 ± 7.4; of female ones was 18.43 ± 4.4; of alcoholic ones was19.5 ±7.5; of non - alcoholic ones was 19.6 ± 5.9. MELD score is available to predict mortality for 6 months after hospitalizating (with cut – off 20; AUC 0.69; sensitivity and specificity are 56.0% and 76.6%) and to predict hepatorenal syndrome (with cut – off 25; AUC 0.90; sensitivity and specificity are 83.3% and 85.4%). In this study, prognostic value of MELD score for acute variceal bleeding, spontaneous bacteremia peritonitis, hepatoencephalopathyfor 6 months after hospitalizating have not been found. Conclusions: MELD score is valuable prognostic system for mortality and hepatorenal syndrome in Child Pugh C cirrhotic patients in 6 months after hospitalizing. Key words: cirrhosis, MELD score

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

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.

Prognostic value of AIMS65 score in cirrhotic patients with variceal bleeding

MedPharmRes ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 22-26
Author(s):  
Trong Nguyen Dang Huynh
Keyword(s):  
Variceal Bleeding ◽  
Predictive Value ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Meld Score ◽  
Operating Characteristics ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Ctp Score

Background: In cirrhotic patients, variceal bleeding remains a major cause of death. After a variceal bleeding episode, mortality and rebleeding rates spike for the first 6 weeks before levelling off. We aimed to evaluate the performance of AIMS65 score in comparison with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score in predicting 6-week mortality and rebleeding in cirrhotic patients with variceal bleeding. Method: Data were collected prospectively from patients with cirrhosis and variceal bleeding at Gastroenterology and Hepatology Department of Cho Ray hospital from September 2016 to April 2017. The primary endpoint was 6-week mortality and rebleeding. The prognostic value of AIMS65, CTP, and MELD scoring systems for 6-week mortality and rebleeding was compared by receiver operating characteristics curves (ROC) and the area under the curve (AUC). Results: Among 80 patients, 15% rebled and 25% died during 6-week follow-up. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week rebleeding were 0.68, 0.54, and 0.48, respectively. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week mortality were 0.80, 0.74, and 0.64, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AIMS65 score at the cutoff point of 2 were 95%, 55%, 41.3%, and 97%, respectively. Conclusion: AIMS65 score is a simple yet applicable tool for risk stratification in cirrhotic patients with variceal bleeding. We recommend using AIMS65 score with a cut-off point of 2 to identify patients at increased risk for 6-week mortality after variceal bleeding.

scholarly journals The study of hepatic hemodynamics: research activity or clinical tool?

2013 ◽  
pp. 201-206
Author(s):  
Claudio Puoti ◽  
Lia Bellis
Keyword(s):  
Portal Hypertension ◽  
Venous Pressure ◽  
Preoperative Assessment ◽  
Clinical Tool ◽  
Research Activity ◽  
Acute Variceal Bleeding ◽  
Routine Work ◽  
Hepatic Hemodynamics ◽  
Pros And Cons ◽  
Cirrhotic Patients

Portal hypertension is a progressive complication of cirrhosis. Therefore, the management of a patient with cirrhosis and gastrointestinal bleeding depends largely on the stage of the portal hypertension. The patient may be in the pre-variceal stage or present with acute variceal bleeding, in which case the objectives are to control the current hemorrhage and prevent recurrence. In clinical practice, the severity of portal hypertension can be estimated, reliably and safely, by transjugular measurement of the hepatic venous pressure gradient (HVPG). After a brief review of the pathophysiology of portal hypertension in cirrhosis, the authors describe the technique used to measure transjugular HVPG, its prognostic value in patients with cirrhosis, the pros and cons of including this procedure in routine work-ups of these patients, and its potential roles in monitoring responses to treatment and in the preoperative assessment of cirrhotic patients undergoing hepatic resection.

scholarly journals Short-Term Outcome of Patients with Cirrhosis and Concurrent Portal Cavernoma Presenting with Acute Variceal Bleeding

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Xuefeng Luo ◽  
Wanqin Wang ◽  
Xiaoli Fan ◽  
Ying Zhao ◽  
Xiaoze Wang ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Variceal Bleeding ◽  
Day Treatment ◽  
First Episode ◽  
Control Group ◽  
Short Term ◽  
Term Outcome ◽  
Acute Variceal Bleeding ◽  
Portal Cavernoma ◽  
Cirrhotic Patients

Background and Aim. The outcome of cirrhotic patients with main portal vein occlusion and portal cavernoma after the first episode of acute variceal bleeding (AVB) is unknown. We compared short-term outcomes after AVB in cirrhotic patients with and without portal cavernoma. Methods. Between January 2009 and September 2014, 28 patients with cirrhosis and portal cavernoma presenting with the first occurrence of AVB and 56 age-, sex-, and Child-Pugh score-matched cirrhotic patients without portal cavernoma were included. The primary endpoints were 5-day treatment failure and 6-week mortality. Results. The 5-day treatment failure rate was higher in the cavernoma group than in the control group (32.1% versus 12.5%; p=0.031). The 6-week mortality rate did not differ between the cavernoma and control group (25% versus 12.5%, p=0.137). Multivariable Cox proportional hazard regression analyses revealed that 5-day treatment failure (HR = 1.223, 95% CI = 1.082 to 1.384; p=0.001) independently predicted 6-week mortality. Conclusions. Cirrhotic patients with AVB and portal cavernoma have worse short-term prognosis than patients without portal cavernoma. The 5-day treatment failure was an independent risk factor for 6-week mortality in patients with cirrhosis and portal cavernoma.

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