Factors influencing survival after therapeutic shunts

Cello, John P.; Deveney, Karen E.; Trunkey, Donald D.; Heilbron, David C.; Stoney, Ronald J.; Ehrenfeld, William K.; Way, Lawrence W.

doi:10.1016/0002-9610(81)90170-7

Cited by 38 publications

(4 citation statements)

References 16 publications

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“…Since this In prednisone-treated patients, the prognostic value of CTC was similar to that observed in placebo-treated and early assessment of CTC explain why Categories A and B are more frequent in our patients. Nevertheless, in our patients, CTC had a significant prognostic influence which is similar to that reported for shunted patients (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Value Of Ctc Compared With Other Prognostic Variablessupporting

confidence: 89%

Prognostic Value of Child-Turcotte Criteria in Medically Treated Cirrhosis

Christensen¹,

Schlichting²,

Fauerholdt³

et al. 1984

Hepatology

290

115

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The Child- Turcotte criteria (CTC) (based on serum bilirubin and albumin, ascites, neurological disorder and nutrition) are established prognostic factors in patients with cirrhosis having portacaval shunt surgery. The objective of this study was to evaluate the prognostic value of CTC in conservatively treated cirrhosis. Patients (n = 245) with histologically verified cirrhosis from a control group of a controlled clinical trial were studied. Data at entry into the trial were used to classify patients according to CTC. Survival curves for up to 16 years were made, and survival rates were compared using the log-rank test. Survival decreased significantly with increasing degree of abnormality (A----B----C) of albumin (p less than 0.001), ascites (p less than 0.001), bilirubin (p = 0.02) and nutritional status (p = 0.03). Survival was insignificantly influenced by neurological status (p = 0.11) probably because none of the patients had hepatic coma at entry into the trial. The five variables in CTC were combined to a score. With increasing score, the median survival time decreased from 6.4 years (score 5) to 2 months (scores 12 or more). Furthermore, the mortality from hepatic failure, gastrointestinal bleeding or hepatocellular carcinoma increased significantly with increasing score. CTC provide valuable and easily obtainable prognostic information in cirrhosis. However, CTC are inferior to a prognostic index based on multivariate analysis of prognostic factors.

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Section: Value Of Ctc Compared With Other Prognostic Variablessupporting

confidence: 89%

Prognostic Value of Child-Turcotte Criteria in Medically Treated Cirrhosis

Christensen¹,

Schlichting²,

Fauerholdt³

et al. 1984

Hepatology

290

115

View full text Add to dashboard Cite

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“…Two deaths occurred in each group. As already shown, only Child C is a strong predictor of perioperative death [16]. This study confirms the signif icantly higher postoperative mortality for patients with preoperative low albumin and elevated bilirubin demon strated in portacaval shunts [16],…”

Section: Discussionsupporting

confidence: 72%

Long-Term Results after Distal Splenorenal Shunt

Bowen¹,

Vauthey²,

Vallette³

et al. 1988

Dig Surg

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Forty-seven cases of distal splenorenal shunt were studied. The perioperative mortality for elective and deferred shunts was 3%, and the overall perioperative mortality including the emergency shunts was 10.6%. Recurrent bleeding was 8.4% and long-term encephalopathy was 17%. The overall 5-year survival rate was 55%. In contrast to other reports, alcoholic patients were found to have a significantly better (80%) 5-year-survival rate than the nonalcoholics (35%). Improved survival in the alcoholic group correlated with abstention from alcohol.

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“…Before and since the introduction of the Child classification and its modifications (13)(14)(15)(16)(17), a number of authors described prognostic models (18)(19)(20)(21)(22)(23)(24)(25)(26) based on as few as one (27) and as many as 17 components (ll), but some of these models are so complex that they are clinically impractical (28). Until now, the Child classification and its modifications are by far the most widely used and reported system to describe the prognosis of patients with cirrhosis of the liver.…”

Section: Albumin (Gm/dl) Pseudocbolinesterase (Units/liter) Bilirubinmentioning

confidence: 99%

Prognostic Significance of Serum Bile Acids in Cirrhosis

Mannes¹,

Thieme²,

Stellaard³

et al. 1986

Hepatology

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The value of serum bile acid concentrations for predicting prognosis in cirrhotics was compared with the prognostic significance of clinical and laboratory findings in a prospective 1-year study of 76 patients with cirrhosis. A commercial radioimmunoassay for total serum-conjugated primary bile acids was used. Of 76 patients, 16 died within the follow-up period. The concentration of bile acids in serum more closely correlated with mortality in cirrhosis than the commonly used clinical and laboratory parameters such as the Number Connection Test, ascites, albumin, pseudocholinesterase, bilirubin, prothrombin time and nutritional state. Serum bile acids alone yielded a prediction of mortality comparable to the Child classification. When logistic regression analysis was performed, optimal prediction of prognosis was achieved with the combination of serum bile acids and the Number Connection Test. Serum bile acid levels alone or in combination with the Number Connection Test may be a clinically useful prognostic index in cirrhosis.

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Factors influencing survival after therapeutic shunts

Cited by 38 publications

References 16 publications

Prognostic Value of Child-Turcotte Criteria in Medically Treated Cirrhosis

Prognostic Value of Child-Turcotte Criteria in Medically Treated Cirrhosis

Long-Term Results after Distal Splenorenal Shunt

Prognostic Significance of Serum Bile Acids in Cirrhosis

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