Mean Child-Turcotte-Pugh Score Research Articles

Correlation of Model for End Stage Liver Disease (MELD), MELD-Sodium (MELD-Na), and Child-Turcotte-Pugh (CTP) Score With Frailty in Patients With Hepatitis C Virus (HCV) Related Cirrhosis.

The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients.Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis. This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1stJanuary 2022 to 30thJune 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant. A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001). Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.

English

BACKGROUND Chronic liver disease causes an imbalance in the coagulation system, but available data on liver disease and risk of venous thrombosis are conflicting. Clinical studies are therefore needed to understand the prevalence and risk factors associated with mortality to decide appropriate care of these patients. We studied the incidence of venous thrombosis in three CTP (Child-Turcotte-Pugh) class of cirrhotic patients and associated risk factors predicting 90-day mortality. METHODS A cross sectional observational study of one-year duration was conducted at a tertiary-care teaching hospital among patients admitted with chronic liver disease. 150 hospitalised patients with cirrhosis were enrolled and followed up for 3 months. Incidence of thrombosis was recorded in different CTP subclass. Threemonth mortality rates in different subgroups were compared by using normal test of proportions. The association between types of thrombosis and CTP class of liver cirrhosis was studied using Mann-Whitney U test, a non-parametric test. Mortality association with various parameters was evaluated using non-parametric test. Pvalue of ≤ 0.05 was considered significant. RESULTS Incidence of venous thrombosis in cirrhotic patients was 4 % in this study. Association of thrombosis with various clinical parameters and different CTP subclass was statistically non-significant. During the 3-months follow-up 24 patients died. Deceased had higher CTP score (mean CTP score - 9.58) as compared to survivors (mean CTP - 8.48) (P-value 0.049). Presence of ascites (Pvalue 0.037), higher serum urea (P-value 0.001), creatinine (P = 0.004), and total leucocyte count (P = 0.008) were significantly associated with mortality. CONCLUSIONS Thrombosis in chronic liver disease (CLD) especially portal vein is common and presents a therapeutic challenge as these patients are also at increased risk of bleeding. Higher CTP score, serum creatinine, leucocyte count and presence of ascites in CLD patients at admission are poor prognostic markers. KEYWORDS Deep Venous Thrombosis, Chronic Liver Disease, Cirrhosis, Thrombosis, Portal Vein Thrombosis

Hepatitis D virus antibodies and liver function profile among patients with chronic hepatitis B infection in Abuja, Nigeria.

Hepatitis D virus (HDV) is a satellite virus of hepatitis B virus (HBV). An estimated 5% of HBV infected individuals worldwide have HDV infection. There is paucity of studies in Nigeria on the burden of HDV infection. This study aimed at determining the prevalence rate of HDV antibodies among individuals with chronic hepatitis B (CHB) infection and comparing the liver function test (LFT) and disease severity among the anti-HDV positive (anti-HDV+) and anti-HDV negative (anti-HDV-) individuals. A cross-sectional study of 180 CHB infected individuals who were clinically evaluated and tested for HDV antibodies using the Enzyme-linked Immunoassay method. Their LFT profile and Child-Turcotte-Pugh (CTP) were also assessed. Data were analyzed using the SPSS version 17. Their mean age was 35.2 ± 10.4 years. There were 150 (83.3%) and 30 (16.7%) individuals with uncomplicated and complicated CHB infection respectively. Thirty-four (18.9%) of the participants were anti-HDV+. The mean serum ALT, AST, albumin and INR of the anti-HDV+ subjects were 16.5 ± 13.8 IU/L, 26.3 ± 32.6 IU/L, 38.9 ± 7.6 g/L, and 1.2 ± 0.2 respectively. The mean values for the same parameters of the anti-HDV- subjects were 10.8 ± 9.5 IU/L, 13.4 ± 11.2 IU/L, 41.4 ± 6.0 g/L and 1.1 ± 0.2 respectively (p < 0.05). The mean CTP scores in the anti-HDV+ and anti-HDV- subjects were 6.1 ± 2.1 and 5.5 ± 1.2 respectively (p= 0.03). Anti-HDV sero-prevalence rate was 18.9% and anti-HDV+ CHB patients had worse LFT results compared to those who were anti-HDV-.

Results of Sofosbuvir Plus Ribavirin in Patients With Hepatitis C Related Decompensated Cirrhosis

Sofosbuvir (SOF), a direct acting antiviral, has revolutionized the treatment of chronic Hepatitis C Virus (HCV) infection. However, data is scarce about efficacy of SOF plus Ribavarin (RBV) in Indian patients with decompensated cirrhosis. We evaluated the efficacy of SOF plus RBV in decompensated cirrhosis, and compared the outcome with compensated cirrhosis and non-cirrhotics. Consecutive decompensated cirrhotic patients of chronic HCV with detectable HCV RNA were treated with 24-week course of SOF (400mg) plus weight based RBV. Sustained Virological Response (SVR), Child Turcotte Pugh (CTP) and Model for Endstage Liver Disease (MELD) scores were assessed at 36 weeks (i.e. 12 weeks after completion of therapy). Non-cirrhotic chronic hepatitis C patients and patients with compensated cirrhosis treated with SOF plus RBV during the same period were used as controls. During the period of this study ledipasvir and daclatasvir were not available in India. A total of 47 patients [median age 50 (29-82) years, 64% males] with decompensated cirrhosis were included as 'cases' in the study; while, 27 patients with compensated cirrhosis and 29 patients with chronic hepatitis were included as 'controls'. Age, gender, HCV RNA levels, and genotype distribution were similar in cases and controls. The median CTP and MELD scores of cases were 8 (7-12) and 13 (6-25), respectively. Among cases 39 (83%) could complete the therapy, while 1 (2%) was intolerant and 7 (15%) died before completion of therapy. End of Treatment Response (ETR) was achieved in 37/39 (95%) cases. Of these, another 3 died before SVR, and 7 failed to achieve SVR, thus 27/34 (79%) could achieve SVR. Thus according to intention-to-treat analysis, only 27/47 (57%) cases could achieve SVR. In comparison, 24/28 (86%) compensated cirrhotics and 27/28 (96%) of chronic hepatitis achieved SVR. There was a significant improvement in mean CTP score in cases who achieved SVR (P<0.01) compared to those who did not achieve SVR/ETR. On multivariate analysis the only independent factor influencing successful outcome patients was a serum albumin >3.5g/dL. A 24-week course of SOF plus ribavirin in decompensated HCV cirrhosis could lead to SVR in only 57% of patients. The failure of therapy in 43% patients was either due to non-response, intolerance, or death. A serum albumin of more than 3.5 is associated with success of antiviral therapy. Thus an early initiation of antiviral therapy is recommended before decompensation sets in as it precludes successful outcome.

Value of the albumin‑bilirubin score in the evaluation of hepatitis B virus‑related acute‑on‑chronic liver failure, liver cirrhosis, and hepatocellular carcinoma

The aim of the present study was to investigate the value of the albumin-bilirubin (ALBI) score in the assessment of the disease conditions of hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF), HBV-related liver cirrhosis (HBV-LC) and HBV-related hepatocellular carcinoma (HBV-HCC). A total of 395 patients with HBV-ACLF, HBV-LC, or HBV-HCC were retrospectively studied. The ALBI, Child-Turcotte-Pugh (CTP), and Model for End-Stage Liver Disease (MELD) scores of the patients were calculated, and the relationships between the ALBI score and the CTP and MELD scores were investigated. Furthermore, the ALBI grading was tested for the evaluation of the severity and stages of HBV-ACLF, HBV-LC, and HBV-HCC, especially when classifying the clinical stages of HBV-ACLF. The mean ALBI scores of the HBV-ACLF, HBV-LC, and HBV-HCC patients were -1.17±0.55, -1.76±0.66 and -2.59±0.62, respectively; the mean CTP scores were 10.70±1.81, 8.19±1.25 and 5.81±1.22, respectively; and the mean MELD scores were 19.93±7.44, 11.10±4.39 and 7.01±3.22, respectively. The ALBI scores were positively correlated with the CTP and MELD scores. The mean ALBI score and the frequency of grade 3 disease were higher in HBV-ACLF patients than in patients with HBV-LC or HBV-HCC. A later HBV-ACLF stage resulted in a higher frequency of ALBI grades of 3. In conclusion, ALBI scores exhibited parallel tendencies to the CTP and MELD scores in HBV-ACLF, HBV-LC, and HBV-HCC patients; thus, ALBI grading may be a simple but applicable method for the evaluation of the functional status of patients with HBV-related end-stage liver diseases.

A quality of life assessment and the correlation between generic and disease-specific questionnaires scores in outpatients with chronic liver disease-pilot study.

Chronic liver diseases (CLD) are an important cause of morbidity and mortality in general population. The aim of this study was to analyze potential differences between patients with CLD and healthy control group, and to estimate the severity of CLD by using simple questionnaires: general health questionnaire (GHQ-12) and chronic liver disease questionnaire (CLDQ). A cross-sectional pilot study was performed in Zemun Clinical Hospital during years 2014 and 2015. Sixty participants were divided into 4 groups (15 per group): chronic alcoholic hepatitis, other chronic hepatitis, liver cirrhosis, and healthy control group. Entire study population chose one of four offered answers of structured questionnaires GHQ-12 and CLDQ, based on which mean model of end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores were calculated. Mean GHQ12 and CLDQ scores were 10.5 and 5.21 ± 1.11 respectively. Regarding certain CLDQ domain scores, a significant difference between alcoholic and non-alcoholic hepatitis groups in the worry domain was observed. Mean MELD score was 7.42 ± 2.89 and did not differ between chronic hepatitis groups, while mean CTP score was 5.73 ± 0.88. A statistically significant correlation was observed between GHQ12 and CLDQ scores (ρ = -0.404, p < 0.01), but not between subjective and objective scores. Mean GHQ12 and CLDQ scores pointed out to general psychological no-distress condition of the studied participants, as well as scarcely expressed CLD-specific complaints. Mean MELD and CTP scores indicated stable chronic liver diseases, with low three-month mortality rates in the cases of chronic hepatitis, as well as determination to Child A group in the case of liver cirrhosis.

Tadalafil, a Phosphodiesterase-5 Inhibitor, Improves Erectile Dysfunction in Patients with Liver Cirrhosis

Background and aim: Erectile dysfunction (ED) is common in patients with liver cirrhosis. Though ED leads to a significant deterioration in the quality of life, it is often neglected by most caregivers as well as researchers. This study evaluates the prevalence of ED in patients with cirrhosis, associated factors, and response to treatment with Tadalafil, a phosphodiesterase-5 inhibitor. Methods: Sixty male patients with Child-Turcotte-Pugh (CTP) score between 5 and10 and no evidence of overt hepatic encephalopathy (HE) were studied. ED was assessed by International Index of Erectile Function (IIEF) questionnaire, and the patients were divided into 2 groups on the basis of presence (ED+) or absence (ED-) of ED. Minimal HE was diagnosed by Psychometric Hepatic Encephalopathy Score (PHES ≤ −5). Patients who had IIEF score < 25 were given Tadalafil, a Phosphodiesterase-5 inhibitor, 10 mg daily for 4 weeks. Results: The mean age of the participants was 45.2 ± 7.8 yrs. Mean CTP score was 6.4 ± 1.7 and median MELD score was 11 (Range 7–30). 27 (45%) patients had compensated cirrhosis and 45 (75%) patients had alcohol as etiologic factor. 21 (35%) patients were found to have minimal HE. 25 (41.7%) patients had an IIEF score of <25, suggestive of ED. Patients with ED were more likely to be smokers (P = 0.07), had ascites (P = 0.04), had more use of diuretics (P = 0.03) and had a higher serum creatinine (P = 0.03). Multivariable analysis demonstrated that only smoking (P = 0.04, OR 3.75) was independently associated with the presence of ED (Table). There was a significant improvement in IIEF scores after the treatment for 4 weeks with Tadalafil (baseline 15.1 ± 5.6, 4 weeks 22.0 ± 3.4; P < 0.001; Figure); 11(44%) patients demonstrated resolution. There was no significant difference in the testosterone levels between patients with or without ED.TableMultivariable analysis.PredictorsOdds ratio95% CIp-valueCTP score1.440.93–2.240.10Ascites0.700.14–3.610.67Serum Sodium1.100.91–1.340.35Serum Creatinine0.120.01–1.090.06Diabetes2.930.47–18.050.24Smoking3.751.27–11.100.04Use of Beta blocker7.350.58–91.750.12Use of Diuretics2.080.35–12.350.49 Open table in a new tab Conclusion: ED is common among patients with liver cirrhosis. Tadalafil is effective in improving ED in these patients. The authors have none to declare.

A Randomized, Double-Blind, Controlled Trial Comparing Rifaximin Plus Lactulose With Lactulose Alone in Treatment of Overt Hepatic Encephalopathy

Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Drugs used in the treatment of HE are primarily directed at the reduction of the blood ammonia levels. Rifaximin and lactulose have shown to be effective in HE. We evaluated the efficacy and safety of rifaximin plus lactulose vs. lactulose alone for treatment of overt HE. In this prospective double-blind randomized controlled trial, 120 patients with overt HE were randomized into two groups: (group A lactulose plus rifaximin 1,200 mg/day; n=63) and group B (lactulose (n=57) plus placebo). The primary end point was complete reversal of HE and the secondary end points were mortality and hospital stay. A total of 120 patients (mean age 39.4±9.6 years; male/female ratio 89:31) were included in the study. 37 (30.8%) patients were in Child-Turcotte-Pugh (CTP) class B and 83 (69.2%) were in CTP class C. Mean CTP score was 9.7±2.8 and the MELD (model for end-stage liver disease) score was 24.6±4.2. At the time of admission, 22 patients (18.3%) had grade 2, 40 (33.3%) had grade 3, and 58 (48.3%) had grade 4 HE. Of the patients, 48 (76%) in group A compared with 29 (50.8%) in group B had complete reversal of HE (P<0.004). There was a significant decrease in mortality after treatment with lactulose plus rifaximin vs. lactulose and placebo (23.8% vs. 49.1%, P<0.05). There were significantly more deaths in group B because of sepsis (group A vs. group B: 7:17, P=0.01), whereas there were no differences because of gastrointestinal bleed (group A vs. group B: 4:4, P=nonsignificant (NS)) and hepatorenal syndrome (group A vs. group B: 4:7, P=NS). Patients in the lactulose plus rifaximin group had shorter hospital stay (5.8±3.4 vs. 8.2±4.6 days, P=0.001). Combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of overt HE.

A randomised double blind controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of hepatic encephalopathy

Background and Aims: Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Majority of the drugs used in the treatment of HE are primarily directed at the reduction or elimination of the blood ammonia levels. We evaluated the efficacy and safety of rifaximin plus lactulose versus lactulose alone for treatment of overt hepatic encephalopathy. Methods: In prospective double blind randomized controlled trial, 120 patients with overt HE were randomized in 2 groups, group 1- lactulose (n=57) and group 2- lactulose plus rifaximin (n=63). Primary end point was reversal of hepatic encephalopathy. Secondary end points were mortality and hospital stay. Results: One hundred and twenty patients (mean age 39.4 ± 9.6 years; M: F 89:31) were included in study. Thirty seven (30.8%) patients were in Child-Turcotte-Pugh (CTP) class B and 83 (69.2%) were in CTP Class C. Mean CTP score was 9.7 ± 2.8 and MELD score was 24.6 ± 4.2. 22 (18.3%) had grade 2, 40 (33.3%) had grade 3 and 58 (48.3%) had grade 4 HE at the time of admission. Forty eight (76%) patients in group 2 compared to 29 (50.8%) patients in group 1 had reversal of HE (P<0.004). There was significant decrease in mortality after treatment with lactulose plus rifaximin versus lactulose alone (23.8% Vs 49.1%, P <0.05). Most common cause of death was sepsis (n=43, 55.8%), followed by hepatorenal syndrome (n=11, 25.6%) and GI bleed (n=8, 18.6%). There was no significant difference in cause of death in two groups. Patients in latulose plus rifaximin group had shorter hospital stay (5.8 ± 3.4 vs. 8.2 ± 4.6 days, P =0.001). Conclusions: Combination of lactulose plus rifaximin is more effective than lactulose alone in treatment of HE.

Do Chronic Liver Disease Scoring Systems Predict Outcomes in Trauma Patients With Liver Disease? A Comparison of MELD and CTP

Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. Currently, data regarding the use of CTP in trauma is limited, whereas MELD remains unstudied. We compared MELD and CTP to determine which scoring system is a better clinical outcome predictor after trauma. A review of trauma admissions during 2003-2008 revealed 68 patients with chronic liver disease. Single and multiple variable analyses determined predictors of hepatic complications and survival. MELD and CTP were compared using odds ratios and area under the receiver operating curve (AUC) analyses. A p value ≤0.05 was significant. The mean MELD and CTP scores of the population were 13.1 ± 6.0 and 8.3 ± 1.8, respectively (mean ± SD). Overall, 73.5% had one or more complications and 29.4% died. When survivors were compared with nonsurvivors, no difference in mean MELD scores was found, although mean CTP score (survivors, 7.7 ± 1.5; nonsurvivors, 9.4 ± 1.9; p = 0.001) and class ("C" survivors, 12.1%; "C" nonsurvivors, 56.3%; p = 0.002) were different, with survival relating to liver disease severity. Odds ratios and AUC determined that MELD was not predictive of hepatic complications or hospital survival (p > 0.05), although both CTP score and class were predictive (p < 0.05; AUC > 0.70). Trauma patients suffering from cirrhosis can be expected to have poorer than predicted outcomes using traditional trauma scoring systems, regardless of injury severity. Scoring systems for chronic liver disease offer a more effective alternative. We compared two scoring systems, MELD and CTP, and determined that CTP was the better predictor of hepatic complications and survival in our study population.

MELD Score vs Child Score in Predicting the Outcome of Elective Abdominal Surgical Procedures in Patients with Cirrhosis

Purpose: The aim of this study is to evaluate the outcome of patients with cirrhosis undergoing elective abdominal surgery and to compare the capacity of the Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) scores to predict that outcome. Methods: We conducted a chart review of patients with cirrhosis who underwent general anesthesia between January 1999 and December 2004 at Emory University Hospital and Emory Crawford Long Hospital. Patients with documented cirrhosis undergoing elective abdominal surgery were included. Patients undergoing liver transplantation or other surgical procedures involving the liver were excluded. Patients with evident extrahepatic cholestasis were excluded as well. Results: A total of 617 charts were screened. After the inclusion and exclusion criteria were applied, 66 procedures performed on 62 patients were identified. The mean MELD score was 9.4 ± 3.3, the mean CTP score was 7.3 ± 1.5. Twenty (30.3%) patients were classified as CTP class A, 40 (60.6%) as class B and 6 (9.1%) as class C. The most common procedures were hernia repair (21, 31.8%), cholecystectomy (17, 25.7%), and diagnostic laparoscopy/laparotomy (15, 22.8%). One patient (1.5%) died of pneumonia in the postoperative period. Signs of decompensated liver disease (hepatic encephalopathy, new ascites, variceal hemorrhage) in the postoperative period were noted in 5 patients (7.6%). There was no statistically significant difference in the CTP or MELD scores between patients who developed signs of decompensation and those who did not. Nine patients (13.6%) developed postoperative transaminase elevation (at least twice the baseline value). The patients with postoperative transaminase elevation had a higher baseline MELD (12.3 ± 3.9 vs 9.1 ± 2.6, p = 0.004), but not a higher CTP score (7.7 ± 2.2 vs 7.4 ±1.5, p = 0.68). Conclusions: Our data suggests that elective abdominal procedures in patients with cirrhosis appear to be relatively safe, with a low risk of liver-related complications. The MELD score correlates better than the CTP score with postoperative transaminase elevation. This may reflect an acute injury to the liver in the perioperative period. More studies are needed to better define the roles of the CTP and MELD scores in predicting the outcome of elective surgical procedures in patients with cirrhosis.

Effect of Minimal Listing Criteria on Waiting List Registration for Liver Transplantation: A Process-Outcome Analysis

To determine the level of association between minimal listing criteria (MLC) recognition and outcomes associated with waiting list registration for liver transplantation (LT). A total of 147 patients and 201 patients were identified as first-time referrals for LT evaluation between January 1, 1997, and November 30, 1997 (cohort A), and December 1,1997, and December 31, 1998 (cohort B), respectively. Relevant demographic and clinical information was abstracted from medical records. Minimal listing criteria were defined as a Child-Turcotte-Pugh (CTP) score of 7 or higher. Patient age, sex, hepatic disease etiology, and mean CTP scores were similar between cohorts A and B. However, the proportion of registered patients in cohort B with CTP scores of 7 or higher increased significantly after formal MLC recognition (96% vs 82% for cohort A; P=.001). In cohort A, waiting list registration was based on patient age, male sex, nonalcohol-related hepatic disease, and a CTP score of 7 or higher in the absence of formal MLC. The rate of first-time patient referral was also increased in cohort B vs cohort A after formal MLC recognition (80% vs 69%, respectively; P=.002) despite similar clinical characteristics. Although the number of patients with a CTP score of 10 or higher was greater in cohort B vs cohort A, the proportion of patients with advanced end-stage liver disease was similar (29% vs 26%, respectively; P=.72). The explicit recognition of MLC was strongly associated with improvements in appropriate waiting list registration for LT.