Organ allocation for patients with acute-on-chronic liver failure: Time to look beyond MELD-sodium?

Jalan, Rajiv; Arroyo, Vicente

doi:10.1016/j.jhep.2020.06.030

Cited by 9 publications

(12 citation statements)

References 15 publications

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“…29 The MELD-Na score, which was modified from the MELD score, and includes total bilirubin, INR, creatinine and sodium, has better prognostic ability for the prognosis of patients with ACLF, when compared to the MELD score. 16 The INR is derived from the pro-thrombin time (PT), as a common clinical practice to correct the deficiency of coagulation factors. Patients with cirrhosis have a complex balanced hemostasis between the pro-coagulant and anticoagulant.…”

Section: Discussionmentioning

confidence: 99%

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Association of Elevated Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 with 90-day Outcomes of Patients with Acute-on-chronic Liver Failure: A Cohort Study

Huang¹,

Cai²,

Han³

2022

J Clin Transl Pathol

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Background and objectives:Triggering receptor expressed on myeloid cells-1 (TREM-1) is an important inflammationrelated biomarker. The present study aimed to determine whether this affects the short-term prognosis of patients with acute-chronic liver failure (ACLF). Methods: The serum sTREM-1 levels of 30 healthy subjects (HS), 40 chronic hepatitis patients without cirrhosis and liver failure (CH), 38 liver cirrhosis (LC) patients, and 59 ACLF patients were evaluated by enzyme-linked immunosorbent assay. The predictive accuracy of the logistic model for survival rate within 90 days in patients with ACLF was determined using the area under the receiver operating characteristic curve (AUC).Kaplan-Meier analysis and log-rank test were performed to revalidate the factors l for the 90-day survival rate of patients with ACLF. Results: Compared to the CH, LC and HS groups, the serum sTREM-1 levels of ACLF patients were significantly elevated (p < 0.001). In ACLF patients, the serum sTREM-1 levels further increased in non-survivors (661.51 [494.36-1,028.82] pg/mL), when compared to the survivors (440.92 [308.00-523.21] pg/mL) (p = 0.002). The multivariate logistic regression analysis indicated that serum sTREM-1, sodium, and the international normalized ratio (INR) were independent predictors for the 90-day mortality of patients with ACLF. The AUC value for logit (p) in predicting the 90-day prognosis of ACLF patients was 0.89 (0.78-1.00), with a sensitivity of 70%, a specificity of 89.74%. Conclusions: Serum sTREM-1 is a valuable independent factor for determining the 90-day mortality of ACLF patients. Combining the INR and sodium in the logistic regression model may improve the accuracy in predicting the prognosis.

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Section: Discussionmentioning

confidence: 99%

“…The Model for End-Stage Liver Disease (MELD) score and MELD-Na score were calculated according to the patient's condition on the day of admission. 16 The development of patients with ACLF was assessed based on the laboratory tests and medical records, and the recommendations of relevant guidelines during hospitalization.…”

Section: Lab Methodsmentioning

confidence: 99%

Association of Elevated Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 with 90-day Outcomes of Patients with Acute-on-chronic Liver Failure: A Cohort Study

Huang¹,

Cai²,

Han³

2022

J Clin Transl Pathol

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“…Dies korreliert auch mit dem Mortalitätsrisiko. Allerdings sind von den 5 Parametern zwei, Aszites und die Enzephalopathie, einer subjektiven Einschätzung unterworfen, weswegen eine Allokation von Spenderorganen nach Dringlichkeit anhand dieses Scores nur begrenzt sinnvoll erschien [5]. Zusätzlich erlaubt eine Einteilung in nur drei Schweregrade lediglich eine begrenzte Diskriminierung des De-kompensationsgrades [6].…”

Section: Hintergrundunclassified

“…Zusätzlich bildet der MELD-Na-Score auch andere Risikogruppen nicht ab, die eine erhöhte Mortalität haben und von einer Transplantation profitieren [18] können. Dazu zählen Patienten mit Sarkopenie [19,20] und verringertem funktionellem Status, Aszites, hepatischer Enzephalopathie, hepatopulmonalem Syndrom und Patienten mit spontan bakterieller Peritonitis [5]. Jede Dekompensation einer Leberzirrhose erhöht das Mortalitätsrisiko zusätzlich und ist nicht im MELD-Score abgebildet [21].…”

Section: Kommentarunclassified

“…Besonders bei Patienten mit niedrigen MELD-Scores hat der Grad der Dekompensation einen großen Einfluss auf die Mortalität [23]. Dies unterstützt den Ruf nach einer weiteren Validierung der akuten Dekompensation als Kriterium der Prognoseabschätzung [5,22]. Auch weitere Aspekte wie Transplantatüberleben oder Spendercharakteristika könnten die Diskussion erweitern.…”

Section: Kommentarunclassified

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Evaluation und Notwendigkeit einer Anpassung des MELD Scores in der Eurotransplantregion

et al. 2021

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Mechanisms of Recovery from and Strategies for Survival of Severe Alcoholic Hepatitis and ACLF

Ibrahim,

Jalan

2023

Alcohol and Alcohol-Related Diseases

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Organ allocation for patients with acute-on-chronic liver failure: Time to look beyond MELD-sodium?

Cited by 9 publications

References 15 publications

Association of Elevated Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 with 90-day Outcomes of Patients with Acute-on-chronic Liver Failure: A Cohort Study

Association of Elevated Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 with 90-day Outcomes of Patients with Acute-on-chronic Liver Failure: A Cohort Study

Evaluation und Notwendigkeit einer Anpassung des MELD Scores in der Eurotransplantregion

Mechanisms of Recovery from and Strategies for Survival of Severe Alcoholic Hepatitis and ACLF

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