MELD-Na Score Research Articles

Association Between Different Versions of the Model for End-Stage Liver Disease Score and Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention.

Pre-procedure liver dysfunction was associated with acute kidney injury after percutaneous coronary intervention (PCI). The aim of this study is to assess and compare the predictive value of different liver function scoring systems for contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective PCI. A total of 5,569 patients were retrospectively enrolled. The model for end-stage liver disease (MELD) including albumin (MELD-Albumin) score (AUC=0.661) had the strongest predictive value in comparison to the MELD score (AUC=0.627), the MELD excluding the international normalized ratio (MELD-XI) score (AUC=0.560), and the MELD including sodium (MELD-Na) score (AUC=0.652). In the fully adjusted logistic regression model, the MELD-Albumin score and the MELD-Na score were independently associated with CA-AKI regardless of whether they were treated as continuous or categorical variables; however, this was not the case for the MELD score and the MELD-XI score. Furthermore, the addition of the MELD-Albumin score significantly improved the reclassification beyond the fully adjusted logistic regression model. The study further explored the association between different versions of the MELD score and CA-AKI using restricted cubic splines and found a linear relationship between the MELD-Albumin score and the risk of CA-AKI. The MELD-Albumin score had the highest predictive value for CA-AKI in patients undergoing elective PCI. The addition of the MELD-Albumin score to the existing risk prediction model significantly improved the reclassification for CA-AKI.

Predicting Survival in Combined Heart-Liver Transplantation Compared to Heart Transplantation Alone

<h3>Purpose</h3> As the number of heart-liver transplants increases, an understanding of the benefits and risks becomes increasingly important for appropriate multiorgan allocation. The model for end-stage liver disease and serum sodium level (MELD-Na) score is used as a predictor of survival in patient with liver disease. It is used to prioritize liver transplant recipients on the waitlist. We expected that patients with higher MELD-Na scores who underwent heart-liver transplant would have a higher postoperative survival than those patients with high MELD-Na scores who underwent heart transplant alone. The goal of our study was to determine if MELD-Na is a useful metric for allocating heart-liver transplants. <h3>Methods</h3> We retrospectively analyzed both heart-liver transplant recipients enrolled in the United Network for Organ Sharing database and all heart transplant recipients from the Stanford University with complete data for the covariates used in our model. Recipient MELD-Na scores were calculated for transplant recipients in both groups. The risk of death was assessed using a multivariable Cox proportional hazard model with adjustment for age of donor, age of recipient, recipient diabetes, and recipient intra-aortic balloon pump at time of transplant. We investigated whether MELD-Na predicted survival in heart-liver recipients. <h3>Results</h3> A total of 326 patients enrolled in UNOS underwent heart-liver transplantation and a total of 278 patients underwent heart transplantation at Stanford. The interaction effect of the type of transplant received (heart-liver vs heart alone) and MELD-Na was not significant for survival at 30 days (p = 0.812), 1 year (p = 0.859), 3 years (p = 0.621), and 5 years (p = 0.448). Furthermore, in the heart-liver cohort, MELD-Na did not significantly predict survival at 30 day (p = 0.461), 1 year (p = 0.153), 3 years (p = 0.169), and 5 years (0.169). <h3>Conclusion</h3> We found that patients with higher MELD-Na scores who underwent heart-liver transplantation did not have a higher postoperative survival when compared to those patients with high MELD-Na who underwent heart transplant alone. Therefore, MELD-Na is not a useful metric for allocating heart-liver transplants.

Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study

Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients with ACLF. We prospectively enrolled consecutive adult patients with ACLF with HRS-AKI (satisfying EASL criteria) treated with terlipressin infusion between 14 October 2019 and 24 July 2020. The objectives were to assess the incidence of adverse events, response to terlipressin, course of HRS-AKI and predictors of mortality. A total of 116 patients were included. Twenty-one percent of patients developed adverse effects. Only 1/3rd of patients who developed adverse events were alive at day 90. Sixty-five percent of the patients responded to terlipressin. Nearly 22% developed recurrence of HRS, and 5.2% progressed to HRS-chronic kidney disease. TFS was 70.4% at day 30 and 57.8% at day 90. On multivariate stepwise Cox regression analysis terlipressin non-response (hazard ratio [HR], 3.49 [1.85–6.57]; P < 0.001) and MELD NA score (HR,1.12 [1.06–1.18]; P < 0.001) predicted mortality at day-90. Patients with ACLF who develop terlipressin related adverse events have dismal prognoses. Terlipressin non-response predicts mortality in patients with ACLF and HRS-AKI.

Improving the Model for End-Stage Liver Disease with sodium by incorporating kidney dysfunction types.

We investigated the impact of the inclusion of kidney dysfunction type on the discrimination and calibration of the Model for End-Stage Liver Disease with sodium (MELD-Na-KT) score. We included all adults listed for ≥90 days without exception points from January 1, 2008, through December 31, 2018. We defined kidney dysfunction types as follows: acute kidney disease (AKD; an increase of ≥0.3 mg/dL or ≥50% in serum creatinine in the last 7 days or fewer than 72 days of hemodialysis), chronic kidney disease (CKD; an estimated glomerular filtration rate <60 ml/min/1.73 m2 for 90 days or ≥72 days of hemodialysis), AKD on CKD (met both definitions), or none (met neither definition).We then developed and validated a multivariable survival model with follow-up beginning at the first assessment after 90 days from waitlist registration and ending at the time of death, waitlist removal, or 90 days from enrollment in this study. The predictor variables were MELD-Na and the derived MELD-Na-KT model. In the derivation cohort, kidney dysfunction type was significantly associated with waitlist mortality after controlling for MELD-Na. There was a significant linear interaction between kidney dysfunction type and MELD-Na score. In the validation cohort, we saw an improvement in the discrimination of the model with an increase in the c-index from 0.76 with MELD-Na to 0.78 with MELD-Na-KT (p = 0.002) and a net reclassification index of 10.8% (95% CI, 1.9%-11.4%). The newly derived MELD-Na-KT model had lower Brier scores (MELD-Na-KT 0.042 vs. MELD-Na 0.053). This study demonstrates the feasibility and the potential for objectively defined kidney dysfunction types to enhance the prognostication of waitlist mortality provided by the MELD-Na score.

Assessment of Severity of Liver Cirrhosis and Nutritional status of Cirrhotic patients in Tribhuvan University Teaching Hospital, Kathmandu

Malnutrition is common in chronic liver disease. The general objective of this study was to assess severity and nutritional status of cirrhotic patients in Tribhuvan University Teaching Hospital (TUTH). A cross-sectional study was carried out among 88 cirrhotic patients of age group of ≥18 years. Information regarding general profile of patient, Child Turcotte Pugh score (CTP), Model for End Stage Liver Diseases-Na Score ( MELD-Na), Subjective Global Assessment (SGA), Mid Arm Circumference (MAC), Triceps Skin Fold Thickness (TST), Mid Arm Muscle Circumference (MAMC) and Functional Assessment: Handgrip Strength (HGS) was collected. SPSS version 20 was used to analyse data. Majority (56.8%) belonged to CTP grade C, 31.8% belonged to CTP grade B and 11.4% patients belonged to CTP grade A. Majority, 72.7%, 71.6% and 65.9% were malnourished when assessed using SGA, TST and MAC respectively. Majority, 86.4% of the patients had impaired handgrip strength. SGA, TST, MAC and HGS were significantly associated with CTP whereas no any statistically significant association was found between Child-Pugh and MAMC. There was statistically significant difference among the MELD Na means among SGA and HGS classes. The mean MELD Na scores did not significantly differ between among the TST, MAC and MAMC classes. The early diagnosis of the nutritional state and the treatment of malnutrition in cirrhotic patients can contribute to a reduction in the frequency and/or severity of these complications. SGA, TST, MAC and HGS are the non-invasive and easy methods of nutritional assessment of cirrhotic patients to use in regular clinical practice at bed side.

Acute kidney injury defined by cystatin C may be superior for predicting the outcomes of liver cirrhosis with acute gastrointestinal bleeding

Background & Aims Acute kidney injury (AKI) is conventionally evaluated by a dynamic change of serum creatinine (Scr). Cystatin C (CysC) seems to be a more accurate biomarker for assessing kidney function. This retrospective multicenter study aims to evaluate whether AKI re-defined by CysC can predict the in-hospital outcomes of patients with liver cirrhosis and acute gastrointestinal bleeding. Methods Overall, 677 cirrhotic patients with acute gastrointestinal bleeding, in whom both Scr and CysC levels were detected at admissions, were screened. eGFRScr, eGFRCysC, and eGFRScr-CysC were calculated. MELD-Na score and AKI were re-evaluated by CysC instead of Scr. Odds ratios (ORs) were calculated in the logistic regression analyses. The receiver operating characteristic (ROC) curve analyses were performed. Results Univariate logistic regression analyses demonstrated that baseline Scr and CysC levels, eGFRScr, eGFRCysC, eGFRScr-CysC, original MELD-Na score defined by Scr, MELD-Na score re-defined by CysC, and AKI re-defined by CysC, but not conventional AKI defined by Scr, were significantly associated with in-hospital death. ROC analyses showed that baseline CysC level, eGFRScr, eGFRCysC, eGFRScr-CysC, original MELD-Na score defined by Scr, and MELD-Na score re-defined by CysC, but not baseline Scr level, could significantly predict the risk of in-hospital death. Conclusions AKI re-defined by CysC may be superior for predicting the in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding.

Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy

BackgroundHepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes, patients were categorized into either improved or deceased. Demographic, clinical, and laboratory data as well as prognostic scores were compared in both deceased and improved groups. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was calculated for each score. Backward logistic regression analysis was used to identify the predictors of mortality.Results60.5% of patients were males. The mean age was 61.09 ± 8.94 years. The main precipitating factors of HE was infections predominantly spontaneous bacterial peritonitis (n = 108, 54.0%) followed by variceal bleeding (n = 39, 19.5%). All scores were significantly higher in the deceased patients. AUROC were 0.734 (CI95% 0.666–0.803), 0.717 (CI95% 0.647–0.787), 0.663 (CI95% 0.589–0.738), 0.626 (CI95% 0.549–0.704), and 0.609 (CI95% 0.531–0.686) for CLIF-SOFA, MELD-Na, MELD, APACHE II, and CTP scores, respectively. MELD, MELD-Na, and CLIF-SOFA scores were the independent predictors of mortality. Among these scores, CLIF-SOFA was the strongest independent predictor of mortality (OR = 1.142, CI95% = 0.888–1.467, p = 0.001).ConclusionsCLIF-SOFA score was superior to other prognostic scores in predicting mortality in hospitalized patients with HE type C.

Left atrial reservoir strain may be a load independent index of diastolic dysfunction in liver cirrhosis patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction. Specifically, diastolic dysfunction has been correlated with the prognosis in liver cirrhotis patients independently of the disease severity. Left atrial reservoir strain (LASr) is a novel index which is inversely correlated with left ventricular end-diastolic pressure, but has not been adequately studied in cirrhotic patients. Purpose To investigate the correlations between LASr and diastolic function or disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed and images were analyzed off-line. LASr was calculated semi-automatically using dedicated software and was feasible in 49 patients. Clinical and biochemical examination was used to assess severity of liver disease by calculating MELD-Na score. Results Mean age was 58.0± 8.6 years, 37 (75.5%) were males, mean MELD-Na score was 15.6 ±7.5 and mean LASr was 39.7 ±12.5. LASr correlated with age (r=-0.415, p = 0.003), LAVI (r=-0.329, p = 0.022), e’ (r = 0.476, p = 0.001), E/e (r=-0.401, p = 0.004) and GLS (r=-0.388, p = 0.006), but not with ejection fraction, stroke volume or MELD-Na score. MELD-Na score correlated with ejection fraction (r = 0.316, p = 0.029), stroke volume (r = 0.549, p &amp;lt; 0.001), left atrial volume index (r = 0.575, p &amp;lt; 0.001), GLS (r = 0.521, p &amp;lt; 0.001), right atrial end systolic area (r = 0.368, p = 0.011) and right ventricular diameter (r = 0.541, p &amp;lt; 0.001) reflecting high cardiac output state in patients with advanced cirrhosis. LASr was significantly lower in patients with E/e’ &amp;gt;14 (22.5 ± 13.6) when compared to patients with E/e’ 8-14 (37.3± 10.6, p = 0.039) and E/e’&amp;lt;8 (44.7± 12.0, p = 0.003). The two latter groups also differed significantly (p = 0.034). LASr correlation with E/e’ was the only statistically significant correlation in a multiple regression model including left ventricular end diastolic volume, ejection fraction and left atrial volume (B=-1.371, P = 0.023). Correlation of LASr with MELD-Na score remained non-significant. Conclusion LASr correlates inversely with E/e’ ratio in liver cirrhotic patients, but does not correlate with load dependent echocardiographic parameters and disease severity. Hence in this special population, LASr may be an earlier and more specific index of diastolic dysfunction than traditional echocardiographic indices. Further studies are needed to examine the prognostic significance of LASr in cirrhotic patients.

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure.

Objectives: In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF. Methods: Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King’s College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson’s disease (WD). Results: PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07, p = 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57, p < 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47, p < 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90, p = 0.0032; 37.29 vs. 18.79, p < 0.0001; 34.29 vs. 19.24, p = 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King’s College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index. Conclusions: Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.

Patients With Cirrhosis Who Have a Model for End-stage Liver Disease Sodium Score of 8 or Greater Are at Increased Risk of Poor Outcomes in Operatively Treated Tibia Fractures.

The purpose of this study was to compare 30-day readmission rates for cirrhotic and non-cirrhotic patients after tibia fracture fixation by retrospectively identifying all surgically managed tibial plateau, tibial shaft, and pilon fractures from 2010 through 2018 in the National Surgical Quality Improvement Program database (N=14,028). The primary outcome measure was 30-day readmission rates. Secondary outcome measures included 30-day rates of reoperation, length of stay, pulmonary embolism, deep venous thrombosis, and wound complications, including deep or superficial infection. Cirrhotic patients (n=665) and non-cirrhotic patients (n=13,363) were identified using the aspartate aminotransferase to platelet ratio index test. Cirrhotic patients were more likely to have preoperative ascites, renal failure, bleeding disorders, and preoperative transfusions. No differences were reported between the two groups in readmission rate or any of the secondary outcome measures, except that cirrhotic patients' length of stay was longer by 0.5 day. Stratification of the cirrhotic cohort demonstrated that a Model for End-stage Liver Disease sodium (MELD-Na) score of 8 or greater was associated with a 4.1-fold increase in the rate of readmission (5.9% vs 1.5%; P<.01). No other differences were identified based on MELD-Na score stratification. Patients with advanced cirrhosis (MELD-Na score ≥8) have an increased risk of 30-day readmission after tibia fracture surgery. Cirrhosis associated with a lower MELD-Na score might not significantly increase the risk of 30-day complications in patients with tibia fractures. [Orthopedics. 2022;45(2):79-85.].

Dipeptidyl peptidase-3 is associated with severity of liver disease and circulatory complications in patients with cirrhosis

Background Patients with cirrhosis suffer from a complex multiorgan disturbance and their prognosis is influenced by the development of portal hypertension and systemic circulatory dysfunction. Although non-invasive techniques such as transient elastography aid in early detection, there is an unmet need for reliable markers of these clinically significant complications. Methods We conducted an exploratory single-center study investigating dipeptidyl peptidase-3 (DPP3) concentrations in various vascular beds in a cohort of 48 patients with cirrhosis and 16 healthy controls. Liver vein catheterisation with sampling from femoral artery and femoral, renal and hepatic veins as well as measurement of hepatic pressure and liver function via indocyanine green and galactose elimination tests were performed. Results DPP3 concentrations were higher in cirrhotic patients compared to controls (12.6 vs. 7.4 ng/mL, p = 0.006) and increased according to the severity of cirrhosis. DPP3 associated with MELD-Na score, Child class, indocyanine green clearance, increased DPP3 with the increased hepatic venous pressure gradient (p = 0.015) as well as increased heart rate and reduced systemic vascular resistance. DPP3 concentrations predicted the presence of clinically significant portal hypertension in cirrhotic patients (AUROC 0.78, 95% CI 0.65–0.9). Conclusion DPP3 is a promising marker for portal hypertension and systemic hemodynamic changes in cirrhosis.

Assessment of frailty in cirrhosis using bedside measures and its correlation with Child-Turcotte-Pugh, MELD & MELD-Na Scores.

Objectives:To assess frailty in cirrhotic by calculating Liver Frailty Index (LFI) using bedside clinical tests and correlate it with Child-Turcotte-Pugh (CTP), MELD, MELD Na, Fib- 4 and Transient Elastography (TE) scoresMethods:This cross-sectional observational comparative study was carried out in Dr Ruth KM Pfau Civil Hospital, Karachi from August 2020 to September 2021. Patients were subjected to three performance-based testing including dominant hand grip strength (HGS), Chair to Stand (CTS) Time & Three Position Balance (TPB). LFI was calculated using the online LFI calculator, available at http://liverfrailtyindex.ucsf.edu and classified as ‘Robust’ if LFI <3.2, ‘Prefrail’ LFI between 3.2 and 4.4, and ‘Frail’ as LFI ≥4.5. Correlation of frailty with MELD, MELD-Na and CTP Scores was done. Means of MELD & MELD-Na Scores and CTP scores were calculated in all 3 classes of frailty using one way ANOVA. A p-value of ≤.05 was taken as significant.Results:Out of 118 patients, 62 (52.5%) were males. Mean MELD score was 11.4 ±3.3, MELD-Na was 15.97 ±8.54, CTP 8.25 ±2.21, Fib-4 was 2.79 ±1.034 and TE score was 18.20 ±9.17. Mean LFI was 3.87 ±1.07; mean HGS was 18.12 ±4.68; mean of CTS was 9.62 ±3.55. LFI Class distribution in our cohort showed Robust were 36 (30.5%), Prefrail 34 (28.8%) and Frail were 48 (40.8%). Correlation of all these variables with LFI showed significant correlation with LFI, but highest correlation coefficient was seen with MELD-Na.Conclusion:Significant correlation between frailty score in cirrhotic with cirrhosis severity scores highlights the need for frequently assessing LFI in all cirrhotic at regular follow up visits.

Standard volume plasma exchange is safe and effective for patients with acute liver failure.

Background and Aim: Plasma exchange (PLEX) is an effective bridging therapy for patients with acute liver failure(ALF). There are no studies comparing the efficacy of standard volume (SV) vs. high volume (HV) PLEX. Therefore, we aimed to compare the safety and efficacy of SV PLEX with HV PLEX. Methods: Patients with ALF who underwent PLEX were included in this retrospective study. The primary outcome was to compare the transplant-free survival among SV (total plasma volume x 1) and HV (total plasma volume x 1.5) PLEX groups at 30-days. Secondary objectives were to compare the effect of SV and HV PLEX on total bilirubin, INR, ammonia levels, SOFA, and MELD Na scores, and the adverse events related to PLEX. Results: A total of 17 patients underwent PLEX(SV-8 and HV-9).The mean age and severity scores (SOFA-4.13 ±1.72 in SV group vs. 4.89±1.7 in HV group; P=0.37) were similar among both the groups. Most common cause of ALF was viral in each group. Fifty percent in SV and 34% in HV group satisfied King’s College Criteria for liver transplantation(P=0.41). Each patient in both the groups underwent a median of 2 sessions of PLEX. Post-PLEX, the change in total bilirubin, INR, ammonia, SOFA, and MELD Na score was comparable. Mortality at seven days was similar among both groups (SV-12.5% vs. 33.3% in HV; P=0.57). Mortality at day 30 was 25% in SV compared to 67% in the HV group (P=0.1). On Kaplan Meier analysis, transplant-free survival at day 30 was similar in both the groups (P=0.26). Two patients in the HV group developed volume overload features and were managed conservatively compared to none in the single volume group. Conclusions: Standard volume plasma exchange has similar efficacy as high volume plasma exchange on severity scores. Standard volume plasma exchange is safe and effective for patients with acute liver failure.

Diagnostic role of simple indices in HCV-related liver cirrhosis outcomes: a prospective cross-sectional study.

Aim of the studyTo evaluate the diagnostic performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin-bilirubin ratio (ABR) and albumin-bilirubin score (ALBI) in different outcomes of liver cirrhosis, including decompensated liver cirrhosis (DLC), acute-on-chronic liver failure (ACLF), hepatocellular carcinoma (HCC), and spontaneous bacterial peritonitis (SBP). A second objective was to find their cut-off values. Finally, we aimed to correlate these indices with the severity of liver cirrhosis.Material and methodsThe study included 149 patients with hepatitis C virus (HCV)-related liver cirrhosis. They were categorized into 3 groups according to severity of cirrhosis as compensated cirrhosis, decompensated liver cirrhosis and acute-on-chronic liver failure based on Child-Turcotte-Pugh (CTP) and MELD-Na scores. Patients were categorized according to presence of HCC and spontaneous bacterial peritonitis. All patients had a complete blood picture and liver profile. NLR, PLR, ALBI and ABR were calculated.ResultsNLR, PLR, ALBI and ABR correlated with CTP, and MELD-Na scores. NLR > 6.27 can be used to predict SBP in patients with ascites. NLR cut-off value > 3.61 and > 5.26 can be used to predict DLC and ACLF respectively in liver cirrhosis. ABR < 0.90 discriminated ACLF from DLC with OR = 2.93 (95% CI).ConclusionsThe simple inflammatory scores NLR and PLR together with simple ABR and ALBI scores can be used as quick tools to assess severity of liver cirrhosis. NLR can predict the presence of SBP in patients with ascites. ABR is superior to ALBI in discriminating ACLF from DLC.

Outcome of Patients Awaiting Deceased Donor Liver Transplantation During COVID-19 Pandemic

Introduction: COVID-19 pandemic caused by SARS-CoV-2 has caused direct as well as collateral damage to the healthcare systems across the world. Reduction in cadaver organ availability may impact patients awaiting deceased donor transplantation. Aim: To determine the clinical outcome of patients awaiting Deceased donor liver transplantation (DDLT) during COVID-19 pandemic. Methods: A retrospective, comparative study of patients awaiting DDLT at our centre from January to December 2020 (pandemic year) against those waitlisted in 2019 (pre-pandemic year) were carried out. Demographics, disease etiology, MELD Na score, clinical event such as DDLT (primary outcome), rescue LDLT or mortality were analyzed between both groups. Chi square test and Student t test was utilized for analysis. A P value of <0.05 considered statistically significant. Results: 175 and 160 patients were awaiting DDLT during the pre-pandemic and pandemic year, respectively. Demographic data of the study population showed age (mean 52±11.2 [95% C.I:50.3- 53.7] vs 52±11.1 [95%C.I:50.4-53.9] years; P=0.911), male:female (6.3:1 vs 6.6:1; P=1.0), etiology of liver disease showed predominantly NASH (92 (52.6%) vs 78 (48.8%);P=0.513)) and ALD (38 (21.7%) vs 41 (25.6%); P=0.440)) in pre-pandemic and pandemic year respectively. Mean MELD Na at the time of listing was 19.6±6.0 [95%C.I:18.7-20.5] vs 19.2±6.3 [95%C.I:18.3-20.2]; P=0.632 and at the time of clinical event was 25±9 [95%C.I:22-27] vs 28±10 [95%C.I:25-31]; P=0.035 between 2019 and 2020 study patients, respectively. Clinical events are as follows: DDLT (21 (12%) vs 10 (6.3%); P=0.089), rescue LDLT (26 (14.9%) vs 12 (7.5%); P=0.039), death on the waiting list (32 (18.3%) vs 44 (27.5%); P=0.05) and awaiting transplant (96 (54.9%) vs 94 (58.8%); P=0.508) and mean duration of patients awaiting liver transplantation was 200 vs 428 days (P=0.00) between the pre-pandemic and pandemic year, respectively. Conclusion: COVID-19 pandemic has caused a considerable reduction in DDLT, leading to a significant longer duration in waitlist and mortality.

EXPERIENCE IN THE USE OF HUMAN ALBUMIN IN COMPLICATIONS OF LIVER CIRRHOSIS AT HOSPITAL JUÁREZ DE MÉXICO

Controlled clinical studies have demonstrated the benefits of albumin in decompensated cirrhotic patients with ascites, elevated creatinine, spontaneous bacterial peritonitis, refractory ascites, hepatorenal syndrome and encephalopathy, in whom the use of albumin improves not only patient survival but also expands intravascular volume, improves microcirculation, binding to numerous substances such as bile acids, nitric oxide and cytokines. However, the time of administration and the dose remains controversial. To present the experience of the administration of human albumin, the clinical and epidemiological factors associated with the success of the treatment in the different complications of hospitalized patients for decompensated cirrhosis in the Gastroenterology Department at Hospital Juárez de México from January 2019 to January 2021. A descriptive, retrospective, observational and cross-sectional study of a cohort of patients hospitalized for decompensated liver cirrhosis in the Gastroenterology Department at Hospital Juárez de México. The records of 63 patients who were administered albumin at a dose of 0.7 gr/kg of body weight were reviewed according to the type of complication, reason for admission, in such a way that epidemiological data, values ​​from laboratory studies, cause of prescription and administration results which were analyzed with measures of central tendency and percentages, obtaining Child Pugh and MELD scores. Of the population studied (N = 63); 42.8% were men (n = 27) with an average age of 57.7 years, 57.1% were women (n = 36) with an average age of 59.42 years. Regarding the etiology of liver disease, the following order was observed: alcohol-related liver disease in 42.8%, MAFLD (metabolic associated fatty liver disease) 42.8%, AIH (autoimmune hepatitis) 4.75%, PBC (primary biliary cirrhosis) 4.75% and HBV (hepatitis B virus) 4.75%. Indications for the use of albumin were spontaneous bacterial peritonitis 53.3%; an acute renal failure that does not respond to fluids, precipitated by: upper gastrointestinal bleeding in 14.2%, urinary tract infection 9.5%, alcoholic hepatitis 9.5%, liver failure due to hepatitis B virus 4%, hepatorenal syndrome 9.5%. 42.8% of the patients in the study cohort had at least one comorbidity. 77.7% of them had type 2 diabetes, 11.1% had type 2 diabetes and arterial hypertension, UC was observed in 11.1% of the population. 4.76% had Child-Pugh score A, 28.57% had Child-Pugh score B and Child Pugh score C 66.66% with an average MELD Na of 25 points. In 94.7% of the cases, effectiveness was observed in the resolution of the complication, 5.3% of the patients, despite the administration of albumin, died of septic shock (secondary to urinary tract infection n = 3, SBP n = 4 and pneumonia n = 1), these patients had Child Pugh C, mean MELD Na 32, and mean serum albumin of 1.8 mg / dl, in contrast to the respondents who had mean serum albumin of 2.62 mg / dl. Unlike what is reported in the literature, we observed that despite the lower doses administered than those recommended in the treatment guidelines, we obtained a 94.7% success rate in treated patients, observing that factors such as serum albumin value, comorbidities, Child Pugh score, MELD-NA and added infectious processes can be determining factors in the results of treatment, which raises the question of: whether the administration of albumin should be individualized according to the clinical characteristics of the patient and not a standardized dose according to their complication. Serum albumin values, the presence of comorbidities, acute infections, and high Child Pugh and MELD Na scores are independent factors that affect the results of human albumin treatment in decompensated cirrhotic patients. The authors declare that there is no conflict of interest

Portal vein thrombosis risk factors in liver transplant candidates.

Background and AimPortal vein thrombosis (PVT) is particularly detected in advanced liver cirrhosis patients. We aimed to analyze the risk factors for PVT in liver transplant candidates.Materials and MethodsDataset for consecutive 165 cirrhotic patients who were evaluated for liver transplantation (LT) were retrospectively analyzed. We sorted patients into two groups: patients with PVT and patients without PVT. Included variables were age, sex, etiology of liver disease, body mass index, MELD-Na score, Child-Pugh score, clinical variables reflecting portal hypertension, and hepatocellular carcinoma. Univariate and multivariate logistic regression analyses were used to identify risk factors of PVT.ResultsOf 165 LT candidates, 46 had PVT (27.9%). Ascites, thrombocytopenia, history of variceal bleeding, and band ligation were risk factors for PVT in univariate analysis. In multivariate analysis, only a history of variceal bleeding (OR 3.45, 95% CI 1.02–11.6, p=0.046) significantly increased the risk of PVT.ConclusionThe previous history of variceal bleeding predicts PVT development in cirrhosis, suggesting that the severity of portal hypertension is a major predictive factor for PVT in patients with cirrhosis. Future prospective studies are needed to risk stratifying cirrhosis patients prior to LT for future PVT development and to define the prophylactic role of anticoagulation in these patients.

The predictive value of MELDNa (model for end-stage liver disease-sodium) and mean platelet volume/platelet count for patients' 30-day mortality after liver transplantation.

Aim of the studyTo investigate the disease-specific score and improve the existing scores to better determine the prognosis of patients after liver transplantation (LT). For this purpose, we evaluated the relationship of prognostic scores with 30-day mortality after LT. In addition, we planned to investigate whether the mean platelet volume/platelet count (MPR) would contribute to score improvement.Material and methodsA total of 178 adult patients admitted to the intensive care unit after LT in our hospital between 2011 and 2019 were retrospectively analyzed. Model for end-stage liver disease-sodium (MELDNa), Child-Turcotte-Pugh (CTP) score, and MPR values were compared in patients with and without 30-day mortality who underwent LT. Logistic regression analysis was performed to determine the predictive factors for mortality. A model was created with multivariate analysis.ResultsOur study included 135 (75.8%) male and 43 (24.2%) female patients. There was a significant difference in the postLT-MELDNa score in the evaluation between those with and without mortality (p < 0.001). Age, postLT-MELDNa and CTP score were found to be significant in terms of the prediction of 30-day mortality in the univariate analysis (p < 0.05). mean platelet volume (MPV) and MPR were not significant in univariate analysis. Multivariate analysis revealed a model in which age and postLT-MELDNa were significant.ConclusionsIn our study, postLT-MELDNa predicted 30-day mortality and was much more effective in predicting mortality when evaluated with age. The MELDNa score, which is currently used in the prognosis of candidates awaiting LT, may be useful for the prognosis of patients after LT in intensive care units.

Disparities in Cirrhosis Management of Black Patients: Do We Know What to Address?

Disparities in Cirrhosis Management of Black Patients: Do We Know What to Address?

Baseline serum cystatin C as a marker of acute kidney injury in patients with acute-on-chronic liver failure.

A creatinine-based estimation of the renal function lags behind the onset of disease process. Cystatin C is a new marker for acute kidney injury (AKI). However, data are limited in patients with acute-on-chronic liver failure (ACLF). We evaluated serum cystatin C as an early predictor of AKI in patients with ACLF. In a prospective observational study, patients with ACLF and normal serum creatinine level were included in the study. Serum cystatin C was analyzed with the development of AKI and the disease outcome. Forty-seven patients (mean age: 43.26±16.34 years; male:female: 2.35:1) were included in the study. AKI developed in 34% of patients during the hospital stay. Receiver operating characteristic (ROC) curve analysis revealed that the best cutoff for baseline cystatin C was 1.47 mg/L with a sensitivity of 0.94 and specificity of 0.68. The cystatin C ((area under the curve [AUC]=0.853) performance was better than that of the creatinine (AUC=0.699), Child-Turcotte-Pugh (CTP) (AUC=0.661), and model for end-stage liver disease-sodium (MELD-Na) (AUC=0.641). In the univariate analysis, age, platelet count, creatinine, estimated glomerular filtration rate (eGFR)-modification of diet in renal disease (MDRD), cystatin C, and estimated glomerular filtration rate-serum cystatin C (eGFRcysC) were significantly associated with AKI in ACLF patients. Cystatin C was an independent positive predictor of AKI. Cystatin C was positively correlated with the MELD-Na scores (r=0.374 and p=0.009). Our study supports previous studies reporting that serum cystatin C is a better predictor for AKI development compared to serum creatinine. Cystatin C may be used as an early marker for new-onset AKI in hospitalized patients with ACLF.