Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List

Abstract

Background: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. Aim:To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. Method: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography. Results: 103 patients were included (without HCC n=58 (66%); HCC n=45 (44%). The mean MELD score was 14.7±6.4, the portal hypertension present on 83.9% and the mean transient elastography value was 32.73±22.5 kPa. The median acoustic radiation force impulse value of liver parenchyma was 1.98 (0.65-3.2) m/s and 2.16 (0.59-2.8) m/s in HCC group. The HCC group was significantly associated with HCV infection (OR 26.84; p<0.0001), higher levels of serum alpha-fetoprotein (OR 5.51; p=0.015), clinical portal hypertension (OR 0.25; p=0.032) and similar MELD score (p=0.693). The area under the receiver operating characteristics (AUROC) showed sensitivity and specificity for serum alpha-fetoprotein (cutoff 9.1 ng/ml), transient elastography value (cutoff value 9 kPa), and acoustic radiation force impulse value (cutoff value 2.56 m/s) of 50% and 86%, 92% and 17% and 21% and 92%, respectively. The survival group had a mean transient elastography value of 31.65±22.2 kPa vs. 50.87±20.9 kPa (p=0.098) and higher MELD scores (p=0.035). Conclusion: Elastography, ultrasound and clinical findings are important non-invasive tools for cirrhosis and HCC on screening for liver transplant. Higher values in liver elastography and MELD scores predict mortality.

Frequency of Hepatocellular Carcinoma and Associated Sociodemographic Factors in Treated Patients of Chronic Hepatitis C

“…High MELD score was significantly associated with the presence of HCC in the study participants. This finding has also been observed in other studies 19 . There could a bidirectional phenomenon; either underlying damaged liver was cause of raised MELD score as well as HCC or the presence of HCC has raised the MELD score at the time of calculation.…”

Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

“…One of them is TE, used for analysis of liver stiffness and steatosis. 5,10,19 In this study, we observed that the result obtained for liver stiffness by TE overestimates the stage of liver fibrosis and demonstrated low agreement between techniques, intermediate sensitivity, and intermediate specificity. It is worse for advanced fibrosis stages (F3/F4) compared to mild and intermediate cases.…”

The Potential Role of Model for End-Stage Liver Disease (MELD)-Sodium Score in Predicting the Severity of Acute Pancreatitis

“…[20]. These formulas represent the advantage of MELD-sodium in predicting the clinical course in the targeted group of patients, which is the objective and case-specific variables without the need for an observer [21].…”

“…The formulas for these scoring systems are as follows: MELD score = 3.78 × ln(serum bilirubin [mg/dL]) + 11.2 × ln(INR) + 9.57 × ln(serum creatinine [mg/dL]) + 6.43; MELD-Na score = MELD score + 1.59 (135 - Na) with maximum and minimum Na values of 135 and 120 mmol/L, respectively [ 20 ]. These formulas represent the advantage of MELD-sodium in predicting the clinical course in the targeted group of patients, which is the objective and case-specific variables without the need for an observer [ 21 ].…”