MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

Horvatits, Thomas; Mahmud, Nadim; Serper, Marina; Seiz, Oliver; Reher, Dominik; Drolz, Andreas; Sarnast, Naveed; Gu, Wenyi; Erasmus, Hans Peter; Allo, Gabriel; Ferstl, Phillip; Wittmann, Sigrid; Piecha, Felix; Groth, Stefan; Zeuzem, Stefan; Schramm, C; Huber, Samuel; Rösch, Thomas; Lohse, Ansgar W.; Trebicka, Jonel; Ogola, Gerald; Asrani, Sumeet K.; Kluwe, Johannes

doi:10.1007/s10620-022-07744-w

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…The addition of lactate to established scoring systems improved their predictive power [ 13 , 14 ], although, in our study, the addition of lactate clearance to GBS and pRS with different weighting did not improve the performance of scoring systems in predicting the need for hemostatic intervention (see Supplementary Materials Table S3 ).…”

Section: Discussionmentioning

confidence: 57%

“…As a product of anaerobic glycolysis, lactate occurs in hypoxic tissue during severe sepsis or hemorrhagic shock. Recently, studies have shown an association of elevated lactate levels with unfavorable outcomes in AUGIB [ 9 , 11 , 12 , 13 ]. Additionally, lactate levels had similar prognostic abilities compared to established risk scores [ 14 ], and it was even shown that incorporating lactate into established risk assessment tools improves the risk scores’ predictive ability [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Allo

Gillessen

Gülcicegi

et al. 2023

JCM

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Early risk stratification is mandatory in acute upper gastrointestinal bleeding (AUGIB) to guide optimal treatment. Numerous risk scores were introduced, but lack of practicability led to limited use in daily clinical practice. Lactate clearance is an established risk assessment tool in a variety of diseases, such as trauma and sepsis. Therefore, this study compares the predictive ability of pre-endoscopic lactate clearance and established risk scores in patients with AUGIB at the University Hospital of Cologne. Active bleeding was detected in 27 (25.2%) patients, and hemostatic intervention was performed in 35 (32.7%). In total, 16 patients (15%) experienced rebleeding and 12 (11.2%) died. Initially, lactate levels were elevated in 64 cases (59.8%), and the median lactate clearance was 18.7% (2.7–48.2%). Regarding the need for endoscopic intervention, the predictive ability of Glasgow Blatchford Score, pre-endoscopic Rockall score, initial lactate and lactate clearance did not differ significantly, and their area under the receiver operating characteristic curves were 0.658 (0.560–0.747), 0.572 (0.473–0.667), 0.572 (0.473–0.667) and 0.583 (0.483–0.677), respectively. Similar results were observed in relation to rebleeding and mortality. In conclusion, lactate clearance had comparable predictive ability compared to established risk scores. Further prospective research is necessary to clarify the potential role of lactate clearance as a reliable risk assessment tool in AUGIB.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Allo

Gillessen

Gülcicegi

et al. 2023

JCM

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“…Compared with other studies on non-variceal UGIB, mortality rates were higher in our study. This might be explained by the significant number of cases with in-hospital bleeding, variceal bleeding and bleeding from malignancies included in this study population, which are associated with high mortality rates of up to 20%, 32% and 47.5%, respectively 22 30 31…”

Section: Discussionmentioning

confidence: 97%

Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary?

Allo,

Lang,

Martin

et al. 2024

BMJ Open Gastroenterol

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ObjectivesThe management of upper gastrointestinal bleeding (UGIB) has seen rapid advancements with revolutionising innovations. However, insufficient data exist on the necessary number of emergency endoscopies needed to achieve competency in haemostatic interventions.DesignWe retrospectively analysed all oesophagogastroduodenoscopies with signs of recent haemorrhage performed between 2015 and 2022 at our university hospital. A learning curve was created by plotting the number of previously performed oesophagogastroduodenoscopies with signs of recent haemorrhage against the treatment failure rate, defined as failed haemostasis, rebleeding and necessary surgical or radiological intervention.ResultsThe study population included 787 cases with a median age of 66 years. Active bleeding was detected in 576 cases (73.2%). Treatment failure occurred in 225 (28.6%) cases. The learning curve showed a marked decline in treatment failure rates after nine oesophagogastroduodenoscopies had been performed by the respective endoscopists followed by a first plateau between 20 and 50 procedures. A second decline was observed after 51 emergency procedures followed by a second plateau. Endoscopists with experience of <10 emergency procedures had higher treatment failure rates compared with endoscopists with >51 emergency oesophagogastroduodenoscopies performed (p=0.039) or consultants (p=0.041).ConclusionsOur data suggest that a minimum number of 20 oesophagogastroduodenoscopies with signs of recent haemorrhage is necessary before endoscopists should be considered proficient to perform emergency procedures independently. Endoscopists might be considered as advanced-qualified experts in managing UGIB after a minimum of 50 haemostatic procedure performed. Implementing recommendations on minimum numbers of emergency endoscopies in education programmes of endoscopy trainees could improve their confidence and competency in managing acute UGIB.

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“…The MELD-Lactate score is a recently developed objective score assessed at hospital admission and it has been shown to better predict in-hospital death due to cirrhosis-related hospitalizations than MELD and MELD-Na alone [24,34,35]. Lactate predicts mortality in relevant patient subgroups, including trauma, pneumonia, decompensated heart failure, and gastrointestinal bleeding [36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Predictors of 30-day mortality in patients diagnosed with hepatic encephalopathy on admission to the emergency department

Yuksek,

Acehan,

Satar

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background The aim of this study is to compare the laboratory findings and disease severity scores of patients diagnosed with hepatic encephalopathy (HE) in the emergency department (ED) to predict 30-day mortality. Method The patients over 18 years old and diagnosed HE in the ED of a tertiary hospital were included in the study. Demographic and clinical characteristics, laboratory parameters, predisposing causes and outcomes of the patients included in the study were recorded in the data form. Severity of liver disease was assessed by Child Pugh Score (CPS), End-stage liver disease model (MELD), MELD-Na and MELD-Lactate scores. Results Two hundred fifty-four patients diagnosed with HE were included in the study. 59.1% of the patients were male. The mean age of the patients was 65.2 ± 12.6 years. The mortality rate of the patients was 47.2%. When the receiver operating characteristic (ROC) analysis, which determines the predictive properties of laboratory parameters and disease severity scores, was examined, the area under curve value of the MELD-Lactate score (0.858 95% CI 0.812–0.904, P < 0.001) was the highest. Binary logistic regression analysis for the estimation of patients’ 30-day mortality showed that CPS and MELD-Lactate scores and blood ammonia and B-type natriuretic peptide levels were independent predictors of mortality. Conclusion According to the study data, MELD-Lactate and BNP levels in patients diagnosed with HE in the ED may help the clinician in the prediction of 30-day mortality in the early period.

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MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

Cited by 9 publications

References 33 publications

Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding

Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary?

Predictors of 30-day mortality in patients diagnosed with hepatic encephalopathy on admission to the emergency department

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