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Meld score

Robyn Laube, Hogan Wang, Laura Park, Joanne K Heyman, Helen Vidot, Avik Majumdar, Simone I Strasser, Geoffrey W McCaughan, Ken Liu
Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiologic parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients...
June 23, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Adrienne Lenhart, Salwa Hussain, Reena Salgia
BACKGROUND: Acute kidney injury in the setting of alcoholic liver disease portends a poor prognosis without liver transplant. AIMS: Using a tertiary care population, we aimed to evaluate the outcomes of renal replacement therapy in patients with alcoholic liver disease and acute kidney injury with < 6 months sobriety. METHODS: A retrospective review of hospitalized patients with alcoholic hepatitis/acute on chronic alcoholic cirrhosis and hepatorenal syndrome or acute tubular necrosis was performed...
June 22, 2018: Digestive Diseases and Sciences
Delphine Weil, Jean-Paul Pais de Barros, Guillaume Mourey, Caroline Laheurte, Benoit Cypriani, Nicolas Badet, Eric Delabrousse, Emilie Grandclément, Vincent Di Martino, Philippe Saas, Laurent Lagrost, Thierry Thévenot
BACKGROUND&AIMS: The quantification of lipopolysaccharide (LPS) in biological fluids is challenging. We aimed to measure plasma LPS concentration using a new method of direct quantification of 3-hydroxymyristate (3-HM), a lipid component of LPS, and to evaluate correlations between 3-HM and markers of liver function, endothelial activation, portal hypertension and enterocyte damage. METHODS: Plasma from 90 non-infected cirrhotic patients (30 Child-Pugh [CP]-A, 30 CP-B, 30 CP-C) was prospectively collected...
June 22, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Matthias Buechter, Guido Gerken, Dieter P Hoyer, Stefanie Bertram, Jens M Theysohn, Viktoria Thodou, Alisan Kahraman
BACKGROUND: Acute liver failure (ALF) is a life-threatening entity particularly when infectious complications worsen the clinical course. Urgent liver transplantation (LT) is frequently the only curative treatment. However, in some cases, recovery is observed under conservative treatment. Therefore, prognostic tools for estimating course of the disease are of great clinical interest. Since laboratory parameters sometimes lack sensitivity and specificity, enzymatic liver function measured by liver maximum capacity (LiMAx) test may offer novel and valuable additional information in this setting...
June 20, 2018: BMC Anesthesiology
Adnan Taş, Mehmet Suat Yalçın, Bünyamin Sarıtaş, Banu Kara
Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs) with hepatic encephalopathy. These include the Child-Turcotte-Pugh (CTP) classification, 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). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosis of patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy...
June 14, 2018: Turkish Journal of Medical Sciences
Catherine T Frenette, Giuseppe Morelli, Mitchell L Shiffman, R Todd Frederick, Raymond A Rubin, Michael B Fallon, Jason T Cheng, Matt Cave, Saira A Khaderi, Omar Massoud, Nikolaos Pyrsopoulos, James S Park, James M Robinson, Mason Yamashita, Alfred P Spada, Jean L Chan, David T Hagerty
BACKGROUND & AIMS: Caspase-mediated apoptosis and inflammation contribute to progression of liver disease. Emricasan is a pan-caspase inhibitor that reduced serum markers of apoptosis and liver inflammation in patients with hepatitis C and non-alcoholic steatohepatitis (NASH). METHODS: We performed a multicenter study of 86 patients with cirrhosis (Child-Pugh class A or B; mean score, 6.9; 38% with alcohol-associated cirrhosis, 29% with HCV-associated cirrhosis, and 23% with NASH) and model for end-stage liver disease (MELD) scores of 11-18 (mean, 12...
June 15, 2018: Clinical Gastroenterology and Hepatology
Fang Wang, Shu Cui, Fengmei Wang, Fenghui Li, Fei Tang, Xu Zhang, Yanying Gao, Hongmin Lv
OBJECTIVE: Determine the optimal scoring system for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with acute variceal bleeding (AVB). Prediction effects of six scoring systems, AIMS65 score, Glasgow-Blatchford (GBS) score, full Rockall (FRS) score, the model for end-stage liver disease (MELD), the MELD-Na model and the Child-Turcotte-Pugh (CTP) score were analyzed in this study. METHODS: A total of 202 liver cirrhosis patients with AVB were enrolled between 1 January 2014, and 31 December 2014...
June 17, 2018: Scandinavian Journal of Gastroenterology
David E Long, Mark Tann, Ke Colin Huang, Gregory Bartlett, James O Galle, Yukie Furukawa, Mary Maluccio, John A Cox, Feng-Ming Spring Kong, Susannah G Ellsworth
PURPOSE: Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated. METHODS AND MATERIALS: We studied 17 patients who underwent HIDA scans before SBRT...
May 1, 2018: Practical Radiation Oncology
Amr Badawy, Toshimi Kaido, Yuhei Hamaguchi, Takayuki Anazawa, Shintaro Yagi, Ken Fukumitsu, Naoko Kamo, Hideaki Okajima, Shinji Uemoto
BACKGROUND: To improve the outcome of living donor liver transplantation (LDLT), a scoring system that could predict accurately the patient and graft survival posttransplant is necessary. The aim of this study is to evaluate our previously proposed Muscle-model for end-stage liver disease (M-MELD) score and to compare it with the other available scores to find the best system that correlates with postoperative outcome after liver transplant. METHODS: We retrospectively reviewed the data of 199 patients who underwent LDLT from January 2010 to July 2016 and calculated the preoperative MELD, MELD Na, the product of donor age and MELD (D-MELD), M-MELD, integrated MELD, and the balance of risk (BAR) score in all patients...
January 1, 2018: Progress in Transplantation
Darko Radakovic, Dragan Opacic, Jochen Börgermann, Wan Chin Hsieh, Manuel Krutzinna, Jan Gummert, Anas Aboud
OBJECTIVES: Prognosis after pericardiectomy for constrictive pericarditis (CP) is affected by the aetiology of the constriction as well as by concomitant cardiac and non-cardiac disease, including liver dysfunction. However, few data exist on the risk stratification that accounts for liver function in patients with CP. We evaluated the effectiveness of the model for end-stage liver disease (MELD) score, an established measure of liver dysfunction, in predicting long-term survival and identifying other risk factors for death...
June 9, 2018: Interactive Cardiovascular and Thoracic Surgery
Yohei Mano, Tomoharu Yoshizumi, Kyohei Yugawa, Masafumi Ohira, Takashi Motomura, Takeo Toshima, Shinji Itoh, Noboru Harada, Toru Ikegami, Yuji Soejima, Yoshihiko Maehara
BACKGROUND: Recent studies revealed that systemic inflammation was correlated with poorer prognosis in various cancers. We investigated the prognostic value of the lymphocyte-to-monocytes ratio (LMR) in patients who underwent living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). METHODS: We retrospectively analyzed the records of 216 patients who underwent LDLT for HCC. Patients were divided into high- (n = 126) and low- (n = 90) LMR groups...
June 12, 2018: Liver Transplantation
Abu Bakar H Bhatti, Faisal S Dar, Muhammad O Butt, Eraj Sahaab, Mohammad Salih, Najmul H Shah, Nusrat Y Khan, Haseeb H Zia, Eitzaz U Khan, Nasir A Khan
Background: The European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) recently proposed diagnostic criteria for acute on chronic liver failure (ACLF). There is lack of data regarding liver transplant outcomes in ACLF patients based on these criteria. The objective of this study was to determine outcome following living donor liver transplantation (LDLT) in ACLF patients. Methods: We retrospectively reviewed patients who underwent LDLT for ACLF based on European association for the study of the liver and chronic liver failure consortium (EASL-CLIF) diagnostic criteria (group 1) ( N  = 60) and compared them with ACLF patients who did not undergo transplantation (group 2) ( N  = 59)...
June 2018: Journal of Clinical and Experimental Hepatology
Narendra S Choudhary, Sanjiv Saigal, Neeraj Saraf, Amit Rastogi, Sanjay Goja, Prashant Bhangui, Srinivasan Thiagrajan, Dheeraj Gautam, Deepak Govil, Vijay Vohra, Arvinder S Soin
Introduction: Although liver transplantation is a definitive cure for Wilson's disease (WD), there is limited data about results of living donor liver transplantation (LDLT) in adults. Material and methods: 18 adults underwent LDLT for WD. The presentations before LDLT were decompensated cirrhosis ( n  = 16), acute on chronic liver failure ( n  = 1) and acute liver failure ( n  = 1). The donors were parents ( n  = 2), siblings ( n  = 3), cousin ( n  = 1), daughter ( n  = 1), nephew ( n  = 1), spouse or relatives of spouse ( n  = 9) and from swap transplantation ( n  = 1)...
June 2018: Journal of Clinical and Experimental Hepatology
Sahaj Rathi, Andrew Fagan, James B Wade, Madhu Chopra, Melanie B White, Dinesh Ganapathy, Chathur Acharya, Radha K Dhiman, Jasmohan S Bajaj
Background: Lactulose is the first-line drug for hepatic encephalopathy (HE), but its acceptance widely differs between Western and Eastern studies. Patient preference for lactulose between different parts of the world has not been examined systematically. Aim: To define the preferences and reasons behind acceptance of lactulose in patients from USA and India. Methods: A discrete-choice questionnaire with six hypothetical scenarios was constructed...
June 2018: Journal of Clinical and Experimental Hepatology
Robert Flisiak, Ewa Janczewska, Mariusz Łucejko, Ewa Karpińska, Dorota Zarębska-Michaluk, Khalil Nazzal, Beata Bolewska, Jolanta Białkowska, Hanna Berak, Katarzyna Fleischer-Stępniewska, Krzysztof Tomasiewicz, Kornelia Karwowska, Krzysztof Simon, Anna Piekarska, Olga Tronina, Ewelina Tuchendler, Aleksander Garlicki
We followed for 2 years patients treated with Direct Acting Agents (DAA) to assess long-term durability of virologic response, improvement of liver function, reduction of liver stiffness (LS), and risk of hepatocellular carcinoma (HCC).The study included patients from 16 hepatologic centers involved in the AMBER, investigators initiated study on treatment of chronic hepatitis C patients within a programme preceding EU registration of Ombitasvir/Paritaprevir/ritonavir±Dasabuvir±Ribavirin. A total of 204 patients among 209 from the primary study were enrolled; 200 with available testing at 2 years follow-up (2yFU) with undetectable HCV RNA (198 responders and 2 non-responders retreated)...
June 11, 2018: Journal of Viral Hepatitis
Rajiv Ranjan Singh, Rama Walia, Naresh Sachdeva, Ashish Bhalla, Akash Singh, Virendra Singh
AIM: Relative adrenal insufficiency (RAI) has been reported in critically ill patients with cirrhosis. We evaluated the prevalence of RAI and its relationship to clinical course in non-septic cirrhosis patients with ascites. METHODS: The study included 66 consecutive non-septic cirrhosis patients with ascites. RAI was defined by a delta cortisol lower than 9 μg/dL and/or a peak cortisol lower than 18 μg/dL. RESULTS: Sixty-six patients with cirrhosis and ascites were studied...
May 23, 2018: Digestive and Liver Disease
Amr Shaaban Hanafy, Sherief Abd-Elsalam, Mohammed M Dawoud
BACKGROUND AND AIM: Anticoagulation therapy is the main line of treatment for acute portal vein thrombosis (PVT) in the absence of cirrhosis. However, the use of this therapy in cirrhotic PVT is still with doubtful evidence. We aimed to evaluate the efficacy and safety of rivaroxaban compared to warfarin for the management of acute non-neoplastic PVT in Hepatitis C virus (HCV)-related compensated cirrhosis. METHODS: Out of 578 patients with chronic HCV infection, 80 patients with acute PVT who had undergone splenectomy due to hypersplenism and 4 patients with acute PVT due to portal pyemia were selected...
June 7, 2018: Vascular Pharmacology
Rahima A Bhanji, Carlos Moctezuma-Velazquez, Andres Duarte-Rojo, Maryam Ebadi, Sunita Ghosh, Christopher Rose, Aldo J Montano-Loza
BACKGROUND: Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis. PURPOSE: The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality. METHODS: A total of 675 cirrhotic patients were studied...
June 7, 2018: Hepatology International
Jasmohan S Bajaj, Puneeta Tandon, Jacqueline G O'Leary, Scott W Biggins, Florence Wong, Patrick S Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer C Lai, Michael Fallon, Paul Thuluvath, Hugo E Vargas, Ram M Subramanian, Leroy R Thacker, K Rajender Reddy
OBJECTIVES: Hyponatremia is associated with poor outcomes in cirrhosis independent of MELD. While intravenous albumin has been used in small series, its role in hyponatremia is unclear. The aim of this study is to determine the effect of albumin therapy on hyponatremia. METHODS: Hospitalized cirrhotic patients included in the NACSELD (North American Consortium for End-Stage Liver Disease) cohort with hyponatremia (Na <130mmol/L) were divided into those receiving intravenous albumin or not...
June 8, 2018: American Journal of Gastroenterology
Hani Oweira, Mahmoud Sadeghi, Daniel Volker, Markus Mieth, Ahmed Zidan, Elias Khajeh, Omid Ghamarnejad, Hamidreza Fonouni, Karl Heinz Weiss, Jan Schmidt, Imad Lahdou, Arianeb Mehrabi
BACKGROUND The Model for End-Stage Liver Disease (MELD) score is a well-established tool for assessing hepatic failure. The present retrospective study investigated whether serum keratin 18 (M65) and caspase-cleaved cytokeratin (M30) were associated with liver dysfunction and post-transplant graft failure. MATERIAL AND METHODS A total of 147 patients with liver cirrhosis were categorized into 2 groups according to their baseline MELD score (group I: MELD score <20, n=87, and group II: MELD score ≥20, n=60)...
June 8, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
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