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Development and validation of a prognostic nomogram for decompensated liver cirrhosis

World Journal of Clinical Cases 2022年第29期10卷 10467-10477页

作者： Wang Zhang Yue Zhang Qi Liu Yuan Nie Xuan Zhu Department of Gastroenterology Jiangxi Clinical Research Center for GastroenterologyThe First Affiliated Hospital of Nanchang UniversityNanchang 330006Jiangxi ProvinceChina

BACKGROUND Decompensated liver cirrhosis(DLC)is a stage in the progression of liver cirrhosis and has a high mortality.AIM To establish and validate a novel and simple-to-use predictive nomogram for evaluating the prognosis of DLC patients.METHODS A total of 493 patients with confirmed DLC were enrolled from The First Affiliated Hospital of Nanchang University(Nanchang,Jiangxi Province,China)between December 2013 and August 2019.The patients were divided into two groups:a derivation group(n=329)and a validation group(n=164).Univariate and multivariate Cox regression analyses were performed to assess prognostic factors.The performance of the nomogram was determined by its calibration,discrimination,and clinical usefulness.RESULTS Age,mechanical ventilation application,model for end-stage liver disease(meld)score,mean arterial blood pressure,and arterial oxygen partial pressure/inhaled oxygen concentration were used to construct the model.The Cindexes of the nomogram in the derivation and validation groups were 0.780(95%CI:0.670-0.889)and 0.792(95%CI:0.698-0.886),respectively.The calibration curve exhibited good consistency with the actual observation curve in both sets.In addition,decision curve analysis indicated that our nomogram was useful in clinical practice.CONCLUSION A simple-to-use novel nomogram based on a large Asian cohort was established and validated and exhibited improved performance compared with the Child-Turcotte-Pugh and meld scores.For patients with DLC,the proposed nomogram may be helpful in guiding clinicians in treatment allocation and may assist in prognosis prediction.

关键词： Decompensated liver cirrhosis Nomogram Prognosis Child-Turcotte-Pugh score meld score

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Patients with Cirrhosis of Liver Operated for Non-transplant Surgery: A Retrospective Analysis

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Journal of Clinical and Translational Hepatology 2019年第1期7卷 9-14页

作者： Kishore Kumar Kuduva Subramanian Manish Tandon Chandra Kant Pandey Priyanka Jain Department of Anaesthesiology Institute of Liver and Biliary SciencesNew DelhiIndia Department of Research Institute of Liver&Biliary Sciences(ILBS)New DelhiIndia

Background and Aims:Patients with cirrhosis of the liver have high mortality after surgery.We investigated the mortality in patients with cirrhosis of the liver who underwent surgery other than liver transplant and applied the Mayo clinic model to predict mortality and compare with the observed mortality.We also studied the association of the observed mortality with the Child-Turcotte-Pugh(CTP)class and the model for end-stage liver disease(meld)and model for end-stage liver disease-sodium(meld-Na)scores.Methods:The electronic records database of our hospital was accessed to analyze the data of 133 cirrhotic patients who underwent various surgeries under general anesthesia from October 2009 to June 2017.The Mayo risk score was applied to each and used to calculate predicted mortality;the meld and meld-Na scores were also calculated.Telephonic interview was performed with the patients and or their relative to ascertain survival or time of death after surgery,when the information was not available from the hospital records.Results:The all-cause observed mortality rates at postoperative days 30 and 90 and at 1 year were 12%,20.3%and 26.3%respectively.The area under the receiver operating characteristic curve values for the Mayo model as a predictor of 30-day,90-day and 1-year mortality were 0.836,0.828 and 0.744 respectively.Good correlation was seen for observed mortality with CTP class and with meld and meld-Na scores.Conclusions:The Mayo model for predicting postoperative mortality in patients with cirrhosis of the liver demonstrated good correlation in this study.The strength of prediction of mortality by Mayo risk score calculation was similar at postoperative days 30 and 90 but decreased at 1-year after the surgery.Good correlation was seen for the observed mortality with meld,meld-Na and CTP scores.

关键词： Cirrhosis of the liver Mayo risk model CTP score meld score

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Infection within 2 weeks before liver transplantation closely related to prognosis of posttransplant infection:A single-center retrospective observational study in China

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 358-364页

作者： Yue Ying Rui-Dong Li Jing-Wen Ai Yi-Min Zhu Xian Zhou Yi-Yi Qian Xin-Chang Chen Xu-Yang Wang Hao-Cheng Zhang Yang Li Shan-Shan Weng Yi-Qi Yu Yi-Feng Tao Yu-Xian Huang Zheng-Xin Wang Wen-Hong Zhang Department of Infectious Diseases Huashan HospitalFudan UniversityShanghai 200040China Department of General Surgery Huashan HospitalFudan UniversityShanghai 200040China

Background:Infections still represent the main factors influencing morbidity and mortality following liver transplantation.This study aimed to evaluate the incidence and risk factors for infection and survival after liver transplantation.Methods:We retrospectively examined medical records in 210 liver recipients who underwent liver transplantation between April 2015 and October 2017 in our hospital.Clinical manifestations and results of pathogen detection test were used to define infection.We analyzed the prevalence,risk factors and prognosis of patients with infection.Results:The median follow-up was 214 days;the incidence of infection after liver transplantation was 46.7%(n=98)which included pneumonia(43.4%),biliary tract infection(21.9%),peritonitis(21.4%)and bloodstream infection(7.6%).Among the pathogens in pneumonia,the most frequently isolated was Acinetobacter baumanii(23.5%)and Klebsiella pneumoniae(21.2%).Model for end-stage liver disease(meld)score(OR=1.083,95%CI:1.045–1.123;Pmeld score after 7 days of transplantation was an independent prognostic factor for postoperative infection in liver transplant recipients.

关键词： Infection Liver transplantation Risk factors meld score

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Refining the Role of Simultaneous Liver Kidney Transplantation

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 289-295页

作者： Sabiha M.Hussain Kalathil K.Sureshkumar Division of Nephrology and Hypertension Department of MedicineAllegheny General HospitalAllegheny Health NetworkPittsburghPAUSA

Adoption of the model for end-stage liver disease score by Organ Procurement and Transplant Network(OPTN)deceased donor liver allocation policy in 2002 has led to an increase in the number of simultaneous liver kidney(SLK)transplantation.Since kidney function recovery following liver transplantation is difficult to predict,al ocation of the kidney for SLK trans-plantation thus far has not been based on much rationale and evidence.Lack of OPTN policy towards SLK organ allocation has resulted in great variations among transplant centers regarding SLK transplantation.Increasing use of kidneys towards SLK transplantation diverts deceased donor kidneys away from candidates awaiting kidney-alone transplantation.Recently OPTN/United Network of Organ Sharing has imple-mented medical eligibility criteria for adult SLK transplantation which also includes a concept of safety net.Implementation of the new policy is a move in a positive direction,providing consistency in our practice and evidence-based guidelines in selecting candidates for SLK transplantation.This policy needs to be monitored prospectively and modified based on new data that wil emerge over time.This review outlines the literature on SLK transplantation and efforts towards developing rational policy on SLK organ allocation.

关键词： Liver kidney transplantation Graft survival meld score Creatinine GFR

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CA-125 Significance in Cirrhosis and Correlation with Disease Severity and Portal Hypertension: A Retrospective Study

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Journal of Clinical and Translational Hepatology 2018年第4期6卷 241-246页

作者： Raja GR Edula Sujit Muthukuru Serban Moroianu Yucai Wang Vivek Lingiah Phoenix Fung Nikolaos T Pyrsopoulos Division of Gastroenterology&Hepatology Rutgers New Jersey Medical SchoolNewarkNJUSA Fairview Hospital Cleveland ClinicFairview ParkOHUSA

Background and Aims:To evaluate the prevalence and significance of elevated cancer antigen-125(CA-125)levels in patients with cirrhosis being treated in a tertiary care liver center and its correlation with objective markers of disease severity.Methods:We retrospectively reviewed medical records of 172 adult patients with cirrhosis(due to any etiology)after obtaining CA-125 serum analysis.Demographics,etiology of cirrhosis,model of end-stage liver disease(meld)score,Child's Turcotte-Pugh classification,albumin bilirubin(ALBI)score,degree of ascites,presence of esophageal varices,serum CA-125 level and various other parameters were collected.Statistical analysis was performed using SPSS software and descriptive statistics.Results:Elevated CA-125 levels were noted in 147 patients(85%)of the study population.Higher meld score was associated with higher CA-125 levels(p=0.001).Statistically significant correlation was observed between elevated CA-125 levels and degree of ascites(pscore(pmeld score or ALBI score.Conclusions:Elevated CA-125 levels were noted in 85%of patients with cirrhosis at our center.Our study establishes that the more advanced the degree of decompensation based on meld score,Child's Turcotte-Pugh classification and ALBI score,the higher the elevation in CA-125.Absence of ascites was associated with normal CA-125 level,with a direct correlation between high levels and worsening ascites,but there was no statistically significant correlation with esophageal varices,indicating that elevated CA-125 levels could be related to mechanical stretch of the peritoneum rather than por

关键词： Portal hypertension Ascites Esophageal varices meld score Child's Turcotte-Pugh classification

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Comparison of Child-Pugh, meld, meld-Na, and ALBI scores in Predicting In-Hospital Mortality in Patients with HCC

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International Journal of Clinical Medicine 2023年第3期14卷 148-162页

作者： Yun Liu Lijian Ran Hongjia Zhang Heling Ren Xin Jiang Pinliang Liao Min Ou Department of Gastroenterology Southwest Hospital The First Affiliated Hospital of Army Medical University Chongqing China Department of Cardiovascular Medicine Southwest Hospital The First Affiliated Hospital of Army Medical University Chongqing China

Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, meld, meld-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, meld, and meld-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, meld-Na may be effective for predicting in-hospital mortality.

关键词： Hepatocellular Carcinoma Child-Pugh score meld score meld-Na score ALBI score In-Hospital Mortality

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Chronic cirrhosis-related splenic artery steal syndrome:evaluation by using proper hepatic artery to splenic artery ratio and Gd-EOB-DTPA-enhanced MR

Chronic cirrhosis-related splenic artery steal syndrome:eval...

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第四届全国医学影像中西医结合青年医师论坛暨第四届《中国...

作者： Yu-dong Xiao Cong Ma Jun Liu Hua-bing Li Bin Zhang Huan Liu Han-lin Fu Jiang-bei Deng Wei-qian Lu Shun-ke Zhou Department of Radiology the Second Xiangya Hospital of Central South University School of Public Health Central South University Department of General Surgery the Second Xiangya Hospital of Central South University Department of Pathology the third Xiangya Hospital of Central South University

Splenic arterial steal syndrome(SASS) is a significant complication after liver transplantation.However,even in chronic liver cirrhosis patients without undergone liver transplantation,the phenomenon of SASS also can be observed.On celiac trunk angiography,SASS is presented as early hyperperfusion of dilatated splenic artery associated with delayed hypoperfusion of constricted hepatic artery.This paper aims to assess the severity of liver cirrhosis and determine the presence of chronic cirrhosis-related SASS by using proper hepatic artery diameter to splenic artery diameter ratio(HSR).In the study,HSR and relative enhancement(RE) of liver parenchyma on Gd-EOB-DTPA-enhanced MR were used to measure the severity of liver cirrhosis expressed as meld score.The optimal cutoff value of HSR or RE for distinguishing patients with healthy liver group to patients with meld score≤10 group,meld score 11-18 group and meld score>18 group were calculated,respectively.A high meld score might be predicted by decreased of HSR,serum albumin,platelets count and increased of serum ALT,presence of ascites.In conclusion,HSR might be used to measure the severity of liver cirrhosis.A low HSR value indicates the presence of SASS especially in those patients with high meld score.

关键词： Gd-EOB-DTPA Cirrhosis Splenic artery Proper hepatic artery meld score

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