MELD-XI Scores Correlate with Post-Fontan Hepatic Biopsy Fibrosis Scores

Evans, William N.; Acherman, Ruben J.; Ciccolo, Michael L.; Carrillo, Sergio A.; Galindo, Alvaro; Rothman, Abraham; Winn, Brody J.; Yumiaco, Noel S.; Restrepo, Humberto

doi:10.1007/s00246-016-1428-1

Cited by 51 publications

(43 citation statements)

References 10 publications

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“…More complex serum fibrosis markers and clinical risk calculators, including the FibroSure test, hyaluronic acid levels, AST‐to‐platelet ratio index score, AST/ALT ratio, Forns index (GGT, platelet count, age, and cholesterol), and Fibrosis‐4 (FIB‐4) score (AST, ALT, platelet count, and age), either are poorly studied in CH or have evidence demonstrating no correlation to fibrosis stage on biopsy . Given the underlying pathophysiology of CH and limited correlation of individual serum markers with fibrosis stage, clinical risk calculators are unlikely to effectively predict fibrosis risk in CH . For example, several models heavily weight aminotransferase values as markers of liver necroinflammation, but CH is not an inflammatory disease .…”

Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

“…The Model for End‐Stage Liver Disease (MELD) excluding international normalized ratio (MELD‐XI) score shows some promise in estimating hepatic fibrosis . In a retrospective study of 73 post‐Fontan patients, elevated MELD‐XI values correlated with increasing total fibrosis scores ( r = 0.4, P = 0.003) . However, the clinical application of this finding should be interpreted with caution because the MELD‐XI score only moderately correlates with fibrosis score and other small studies have failed to demonstrate this correlation (Table ) .…”

Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

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Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

Lemmer¹,

VanWagner

Ganger³

2018

Hepatology

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Congestive hepatopathy (CH) arises from chronically elevated right-sided heart pressures transmitted to the liver by passive venous congestion. Over time, CH can lead to hepatic bridging fibrosis, decompensated cirrhosis, and hepatocellular carcinoma. Currently, there are no evidence-based guidelines to direct appropriate screening or management of patients with CH, partly because of the inability of current clinical tools (serum tests, imaging studies, liver stiffness measurements, and liver biopsy) to accurately estimate hepatic fibrosis or the risk for hepatic decompensation. The Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) score is the only validated serum-based test to predict clinical outcomes in CH. Noninvasive liver stiffness measurements are proving to be of minimal utility as all patients with CH have elevated values that currently cannot differentiate between congestion and fibrosis. In addition, fibrosis staging by liver biopsy is difficult to standardize because of heterogeneous collagen deposition in CH. Moreover, liver biopsy results have little predictive value for post-heart transplant hepatic outcomes in patients with CH. Evaluating liver nodules and masses is also complicated in CH as the finding of delayed venous washout in nodules is not specific for hepatocellular carcinoma in the background of a congested liver, and these lesions may require biopsy to confirm the diagnosis. The lack of effective clinical tools for predicting liver fibrosis and liver function suggests the need for the development of novel biomarkers in patients with CH to assist in the management of this complicated disease. (Hepatology 2018; 00:000-000).

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Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

Section: Noninvasive Biomarkers: Can We Estimate Liver Fibrosis In Comentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

Lemmer¹,

VanWagner

Ganger³

2018

Hepatology

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“…As hyaluronic acid, the Forn index and MELD-XI may reflect fibrotic changes in the liver,11 the RRI might also be associated with liver fibrotic changes.…”

Section: Discussionmentioning

confidence: 99%

Renal resistive index reflects Fontan pathophysiology and predicts mortality

Ohuchi

Negishi

Hayama

et al. 2017

Heart

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“…Previous, large patient cohort studies report correlations between liver pathology and noninvasive methods, including composite models comprised of multiple patient variables, in those with infectious hepatitis, nonalcoholic fatty liver disease, and alcoholic liver disease . However, there are few reports comparing liver biopsy findings with noninvasive approaches in patients with Fontan associated liver disease (FALD); thus, there are no current, useful, clinic‐based, noninvasive methods that strongly correlate one with the other . This study reports our experience comparing post‐Fontan hepatic biopsy findings with a composite, noninvasive index derived from liver‐ultrasound, shear‐wave elastography (SWE) measurements, model for end‐stage liver disease excluding INR (MELD‐XI) scores, and time post‐Fontan.…”

Section: Introductionmentioning

confidence: 98%

A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings

Evans

Acherman

Ciccolo

et al. 2017

Congenital Heart Disease

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Objective: We hypothesized that clinic-based, hepatic-ultrasound, elastography measurements, either alone or in combination with other noninvasive variables, might correlate with liver-biopsy fibrosis scores in patients post-Fontan. Results: We identified a total of 79 post-Fontan patients that underwent cardiac catheterization and liver biopsy. Of the 79 patients, 53 met inclusion criteria, and 32 consented to undergo hepatic-ultrasound elastography. Of the 32 that underwent elastography, data from 30 patients was used for analysis. We found no statistically significant differences in demographics, laboratory values, or cardiac catheterization data between the 30 included patients and the 21 that did not participate. Utilizing data from the 30 included patients, we found a strong, highly statistically significant correlation between the Fontan hepatic index values and total fibrosis scores (R 5 0.8, P < .00001). However, the cohort size prevented reliable discriminating cut-off values for the range of total fibrosis scores.Conclusions: In a small cohort of patients post-Fontan, preliminary findings suggest that the composite Fontan hepatic index might be a clinically useful, noninvasive method of serially monitoring for hepatic fibrosis. Further studies, with large patient cohorts, are necessary to validate our findings and develop clinically useful discriminatory cutoff values. K E Y W O R D SFontan, hepatic fibrosis, shear-wave elastography

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MELD-XI Scores Correlate with Post-Fontan Hepatic Biopsy Fibrosis Scores

Cited by 51 publications

References 10 publications

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

Renal resistive index reflects Fontan pathophysiology and predicts mortality

A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings

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