The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding

Benedeto-Stojanov, Daniela; Nagorni, Aleksandar; Bjelaković, Goran; Stojanov, Dragan; Mladenović, Bojan; Djenic, Nebojsa

doi:10.2298/vsp0909724b

Cited by 32 publications

(20 citation statements)

References 16 publications

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“…7, 8 Liver cirrhosis patients can be classified into three groups, A (least), B (moderate), and C (worst) according to the CP score, 5, 6 with one-year survival rates of 100%, 81% and 45%, respectively. To date, the CP classification is still considered the cornerstone in prognostic evaluation of liver cirrhosis, 9, 10 however, the CP score does not provide direct evidence of the stage of a patient’s cirrhosis and it has some disadvantage that clinical evaluation might be imperfect and biochemical parameters could have similar physiopathological meanings. 11–14 Doctors must make a diagnosis using past clinical experience or an invasive liver biopsy.…”

Section: Introductionmentioning

confidence: 99%

Serum Bile Acids Are Associated with Pathological Progression of Hepatitis B-Induced Cirrhosis

et al. 2016

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Recent metabonomic studies have identified an important role of bile acids in patients with liver cirrhosis. Serum bile acids, such as glycocholate (GCA), glycochenodeoxycholate (GCDCA), taurocholate (TCA) and taurochenodeoxycholate (TCDCA), increased significantly in liver cirrhosis patients. Our recently published urinary metabonomic study showed that glycocholate 3-glucuronide, taurohyocholate, TCA, glycolithocholate 3-sulfate and glycoursodeoxycholate (GUDCA) were markedly increased in hepatitis B-induced cirrhotic patients (n = 63) compared with healthy controls (n = 31). The urinary levels of GUDCA were able to differentiate among three stages of cirrhotic patients with Child Pugh (CP) score A, B and C. In this study, we recruited two new cohorts of patients with hepatitis B-induced cirrhosis and healthy control subjects and quantitatively profiled their serum bile acids using ultra performance liquid chromatography triple quadrupole mass spectrometry. Serum bile acid profile and corresponding differential bile acids were characterized, in addition to the blood routine, liver and renal function tests. The alterations of bile acids contributing to the inter-group variation between healthy controls and cirrhotic patients, and among pathological stages of CP grade A, B and C were also investigated. Five bile acids, GCA, GCDCA, TCA, TCDCA and GUDCA were significantly altered among different stages of liver cirrhosis (n = 85), which was validated with an independent cohort of cirrhotic patients (n = 53). Our results show that dynamic alteration of serum bile acids is indicative of an exacerbated liver function, highlighting their potential as biomarkers for staging the liver cirrhosis and monitoring its progression.

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Section: Introductionmentioning

confidence: 99%

Serum Bile Acids Are Associated with Pathological Progression of Hepatitis B-Induced Cirrhosis

et al. 2016

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“…Therefore, liver function tests and the calculation of MELD and Child-Pugh scores on an every three months basis are recommended [6, 21, 24]. During the initial phase of treatment, the modified Nazer score is a reliable tool to identify patients at risk for hepatic treatment failure requiring liver transplantation [25, 26].…”

Section: Discussionmentioning

confidence: 99%

Comparative assessment of clinical rating scales in Wilson’s disease

et al. 2017

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BackgroundWilson’s disease (WD) is an autosomal recessive disorder of copper metabolism resulting in multifaceted neurological, hepatic, and psychiatric symptoms. The objective of the study was to comparatively assess two clinical rating scales for WD, the Unified Wilson’s Disease Rating Scale (UWDRS) and the Global Assessment Scale for Wilson’s disease (GAS for WD), and to test the feasibility of the patient reported part of the UWDRS neurological subscale (termed the “minimal UWDRS”).MethodsIn this prospective, monocentric, cross-sectional study, 65 patients (median age 35 [range: 15–62] years; 33 female, 32 male) with treated WD were scored according to the two rating scales.ResultsThe UWDRS neurological subscore correlated with the GAS for WD Tier 2 score (r = 0.80; p < 0.001). Correlations of the UWDRS hepatic subscore and the GAS for WD Tier 1 score with both the Model for End Stage Liver Disease (MELD) score (r = 0.44/r = 0.28; p < 0.001/p = 0.027) and the Child-Pugh score (r = 0.32/r = 0.12; p = 0.015/p = 0.376) were weak. The “minimal UWDRS” score significantly correlated with the UWDRS total score (r = 0.86), the UWDRS neurological subscore (r = 0.89), and the GAS for WD Tier 2 score (r = 0.86).ConclusionsThe UWDRS neurological and psychiatric subscales and the GAS for WD Tier 2 score are valuable tools for the clinical assessment of WD patients. The “minimal UWDRS” is a practical prescreening tool outside scientific trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-017-0921-3) contains supplementary material, which is available to authorized users.

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“…Child-Pugh score is useful to predict the outcome of surgery in cirrhotic patients, and to stratify patients on the waiting list for LT [18]. Then, a simple question arises.…”

Section: Discussionmentioning

confidence: 99%

Fibrosing Cholestatic Hepatitis in a Complicated Case of an Adult Recipient After Liver Transplantation: Diagnostic Findings and Therapeutic Dilemma

et al. 2016

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Patient: Male, 66Final Diagnosis: Fibrosing cholestatic hepatitisSymptoms: Prolonged jaundice and intractable ascitesMedication: Steroid pulse therapy and direct-acting antiviralsClinical Procedure: Liver transplantationSpecialty: TransplantologyObjective:Challenging differential diagnosisBackground:Hepatitis C recurrence is a serious matter after liver transplantation (LT). Approximately 10% of hepatitis C virus (HCV) positive recipients develop fibrosing cholestatic hepatitis (FCH). FCH rapidly results in graft loss. Currently, direct-acting antivirals (DAAs) are effective and safe for hepatitis C, even after LT. However, only a few cases of successfully treated FCH after LT have been reported. We present FCH in a complicated case with sepsis and portal flow obstruction after LT.Case Report:A 66-year-old man underwent cadaveric LT. Liver function disorders were observed from post-operative day (POD) 22. Sepsis repeated on POD 38, 74, and 101. Steroid pulse therapy was given from POD 40 to 54. The infectious focus was surgically removed on POD 89. Interventional radiology for portal venous obstruction was completed on POD 96. To make a real-time diagnosis and to investigate the graft condition, repeat liver needle biopsies (LNBs) were taken. Although there was a combined impact of sepsis, portal flow decrease, and recurrent hepatitis C on graft failure, it was interesting that recurrent hepatitis C was consistently detectable from the first LNB. HCV-ribonucleic acid increased on POD 68. Liver function disorders peaked on POD 71 and 72. Jaundice peaked on POD 82. DAA induction was regrettably delayed because of a reluctance to introduce DAAs under conditions of graft dysfunction. DAAs were administered after hospital discharge.Conclusions:A real-time and precise diagnosis based on histopathological examination and viral measurement is important for FCH treatment. Well-considered therapy with DAAs should be aggressively introduced for potentially fatal FCH after LT.

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The model for the end-stage liver disease and Child-Pugh score in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding

Cited by 32 publications

References 16 publications

Serum Bile Acids Are Associated with Pathological Progression of Hepatitis B-Induced Cirrhosis

Serum Bile Acids Are Associated with Pathological Progression of Hepatitis B-Induced Cirrhosis

Comparative assessment of clinical rating scales in Wilson’s disease

Fibrosing Cholestatic Hepatitis in a Complicated Case of an Adult Recipient After Liver Transplantation: Diagnostic Findings and Therapeutic Dilemma

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