Can the MEGX test and serum bile acids improve the prognostic ability of Child-Pughʼs score in liver cirrhosis?

Testa, Roberto; Valente, Umberto; Risso, Domenico; Caglieris, Sergio; Giannini, Edoardo G.; Fasoli, Alberto; Botta, Federica; Dardano, Giovanni; Lantieri, P. B.; Celle, G

doi:10.1097/00042737-199905000-00016

Cited by 34 publications

(31 citation statements)

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“…Nevertheless, it has some drawbacks such as subjectivity of clinical parameters and limited discriminant ability. [5][6][7] Child-Pugh class A patients usually show good medium term survival without OLT unless other events (for example, hepatocellular carcinoma, uncontrolled bleeding due to portal hypertension, etc) occur, 1 8 while Child-Pugh class C patients are considered the conventional candidates for the procedure. Child-Pugh class B patients can be considered a heterogeneous group as their clinical condition may remain stable for more than a year or rapidly deteriorate.…”

mentioning

confidence: 99%

MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study

Botta

Giannini

Romagnoli

et al. 2003

Gut

312

212

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Background: Indices for predicting survival are essential for assessing prognosis and assigning priority for liver transplantation in patients with liver cirrhosis. The model for end stage liver disease (MELD) has been proposed as a tool to predict mortality risk in cirrhotic patients. However, this model has not been validated beyond its original setting. Aim: To evaluate the short and medium term survival prognosis of a European series of cirrhotic patients by means of MELD compared with the Child-Pugh score. We also assessed correlations between the MELD scoring system and the degree of impairment of liver function, as evaluated by the monoethylglycinexylidide (MEGX) test. Patients and methods: We retrospectively evaluated survival of a cohort of 129 cirrhotic patients with a follow up period of at least one year. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. All patients had undergone a MEGX test. Multivariate analysis was performed on all variables to identify the parameters independently associated with one year and six month survival. MELD values were correlated with both Child-Pugh scores and MEGX test results. Results: Thirty one patients died within the first year of follow up. Child-Pugh and MELD scores, and MEGX serum levels were significantly different among patients who survived and those who died. Serum creatinine, international normalised ratio, and MEGX 60 were independently associated with six month mortality while the same variables and the presence of ascites were associated with one year mortality. MELD scores showed significant correlations with both MEGX values and Child-Pugh scores.

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confidence: 99%

MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study

Botta

Giannini

Romagnoli

et al. 2003

Gut

312

212

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show abstract

“…It has, however, several drawbacks such as the subjectivity of clinical parameters, limited discriminative capability and variability in the measurements of laboratory parameters [17,18] . Current CP score modifications by adding new variables or utilizing sophisticated measures did not improve its accuracy to predict survival [19][20][21][22][23][24][25] . A relatively new score, the MELD, Gomez EV et al .…”

Section: Discussionmentioning

confidence: 99%

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Vilar‐Gomez¹,

Bertot²,

Oramas³

et al. 2009

WJG

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AIM:To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. METHODS:We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52-and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ≤ 8 and high risk > 8). RESULTS:In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52-and 104-wk mortality, respectively. In addition, the HosmerLemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

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“…5,28 The failure of Child-Pugh scores to predict successful extubation is more surprising because this variable is considered a reliable predictor of outcome. 29 However, Child-Pugh score tends to correlate better with longterm survival, rather than outcome early in the postoperative course. 9 In previous studies, higher Child-Pugh score, age, and alcoholic liver disease were associated with longer postoperative ventilation and ICU length of stay.…”

Section: Discussionmentioning

confidence: 99%

Reduced use of intensive care after liver transplantation: Patient attributes that determine early transfer to surgical wards

Mandell

Lezotte

Kam

et al. 2002

Liver Transplantation

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Part 1 of our report, presented in the same issue of the Journal, shows that immediate postoperative extubation and direct transfer to the surgical ward is safe and reduces reliance on the intensive care unit in most liver transplant recipients. However, there is no method to preoperatively predict which patients will need ventilatory support after surgery. To address this issue, we examined the relationship between perioperative patient attributes and extubation outcome in patients entered into our immediate postoperative extubation study from 1996 to 1998. Variables chosen stemmed from considerations in the literature. We examined the influence of 13 preoperative and 6 intraoperative factors on extubation outcome. Preoperative attributes included sex, race, diagnosis, United Network for Organ Sharing status, Child-Pugh score, presence of a portosystemic shunt, ascites, encephalopathy, coagulation, age, body mass index (BMI), creatinine level, and year of surgery. Intraoperative factors were type of surgery, surgeon, anesthesiologist, number of red blood cells administered, length of surgery, and surgical start time. Female sex (P ‫؍‬ .02), BMI of 32 or greater (P ‫؍‬ .015), portosystemic shunt (P ‫؍‬ .022), and encephalopathy (P ‫؍‬ .041) were associated with no attempt by the physician to extubate, whereas encephalopathy (P ‫؍‬ .01) and BMI of 34 or greater (P ‫؍‬ .002) were associated with failure to meet criteria for postoperative extubation (described in part 1 of this study). We conclude there are limited factors that predict an increased risk for postoperative respiratory failure in liver transplant recipients. Our results indicate that physicians are conservative in their approach to extubation immediately after surgery, and sole reliance on physician judgment to determine suitability for postoperative extubation leads to unnecessary use of postoperative cardiopulmonary support. (Liver Transpl 2002;8:682-687.)

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Can the MEGX test and serum bile acids improve the prognostic ability of Child-Pughʼs score in liver cirrhosis?

Cited by 34 publications

References 0 publications

MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study

MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Reduced use of intensive care after liver transplantation: Patient attributes that determine early transfer to surgical wards

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