A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

Malinchoc, Michael; Kamath, Patrick S.; Gordon, Fredric D.; Peine, Craig J.; Rank, Jeffrey M.; Borg, Pieter C. J. ter

doi:10.1053/he.2000.5852

Cited by 2,567 publications

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References 31 publications

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“…The primary prognostic factor of interest was race/ethnicity, which was categorized as white, black, Hispanic, and Asian. Additional clinicopathologic data included age, body mass index (BMI), transplantation Model for End-Stage Liver Disease (MELD) scores, 16 HCV serostatus, hepatitis B virus (HBV) antigen positivity, the presence of diabetes mellitus, dialysis requirement before transplantation, education level, Medicaid status, number of tumors, combined tumor size, and total length of stay. Differences in these clinical factors were compared by race and ethnicity.…”

Section: United Network For Organ Sharing: Transplantation Populationmentioning

confidence: 99%

Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

Artinyan

Mailey

Sanchez‐Luege

et al. 2010

Cancer

226

182

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BACKGROUND: Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy. METHODS: Patients with HCC (n ¼ 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n ¼ 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity. RESULTS: The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long-term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83-0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome. CONCLUSIONS: Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC.

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Section: United Network For Organ Sharing: Transplantation Populationmentioning

confidence: 99%

Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

Artinyan

Mailey

Sanchez‐Luege

et al. 2010

Cancer

226

182

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“…22,23 On the day of E-HAP suspicion, the body temperature, white blood cell count, partial pressure of arterial oxygen/fraction of inspired oxygen, purulence and abundance of respiratory secretions, and duration of mechanical ventilation before pneumonia were recorded. Patients were followed throughout their ICU stay until death or discharge from the ICU.…”

Section: Data On Admission To the Icu [Simplified Acutementioning

confidence: 99%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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“…Recently, the Model for End‐stage Liver Disease (MELD) score,11 which reflects liver and renal function and is based on international normalized ratio (INR), total bilirubin, and creatinine, has been widely used as a prognostic predictor in patients with liver and heart diseases 12, 13, 14, 15. Furthermore, the MELD‐XI score, a modified MELD score that excludes INR during calculation because of anticoagulation,16 has been confirmed to be useful in predicting outcomes of various types of cardiac surgery including heart transplantation,17, 18 Fontan surgery,19 and transcatheter aortic valve implantation 20.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

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BackgroundThe Model for End‐stage Liver Disease excluding international normalized ratio (MELD‐XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD‐Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed.Methods and ResultsA total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all‐cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD‐XI and MELD‐Albumin scores were excellent predictors of 1‐year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan–Meier survival curve demonstrated that a high score on MELD‐XI (≥12.0) and MELD‐Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow‐up of 40 months, both MELD‐XI and MELD‐Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome.ConclusionsBoth MELD‐XI score and MELD‐Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.

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A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

Cited by 2,567 publications

References 31 publications

Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

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