MELD-Na is more efficient than MELD to identify subjects with poor outcome and significantly increase the efficacy of the score to predict waitlist mortality. As hyponatremia is associated with poor prognosis in cirrhosis, inclusion of serum sodium (Na) into the MELD (MELD-Na) was found to improve its predictive value in chronic liver diseases. However, some studies have shown that the cut-point of 32 of DFI could be inaccurate and higher cut-offs have been proposed (from 37 to 44).Īlthough MELD score was designed for evaluation of patients awaiting liver transplantation, its use has been expanded and now, is used as a prognostic scale in various liver diseases such as AH, viral hepatitis, hepatocellular carcinoma and autoimmune diseases. Also, DFI allows identifying patients who may benefit from treatment with steroids. A score higher than 32 in the DFI is considered as a severe AH and mortality rates are close to 65% at 28 d. Among the many scoring systems, the DFI is the most used. There are several prognostic models to assess severity in patients with AH including the Maddrey’s discriminant function index (DFI), the Glasgow AH score (GAHS), the age- bilirubin- international normalized ratio (INR) - creatinine (ABIC) score, the Lille score and the model for end-stage liver disease (MELD). Therefore, assessment of the disease severity becomes an important and practical issue for clinicians involved in the management of patients with AH. Patients with severe AH have been reported to have 30-d mortality up to 50%.
Its spectrum is wide and ranges from a silent disease to fulminant liver failure with a high mortality rate. This entity is an acute form of alcohol induced liver injury that is seen in patients who consume large quantities of alcohol during a prolonged period of time. AH was first described by Gordon Beckett in 1961 and clinical description of the syndrome is still valid after 50 years. Chronic alcohol consumption is the leading cause of liver failure in our country, and alcohol intake > 120 g/d is a factor associated with the development of alcoholic hepatitis (AH). It is estimated that 6% of the Mexican population is dependent on alcohol which equals to 4.9 million people. Our results show that MELD-Na is a more valuable model than DFI to predict short-term mortality. MELD-Na was the only predictive factor for mortality at 90 d. Child stage, encephalopathy, ascites, or types of treatment were not associated with mortality. In the univariate analysis, sodium levels was associated with mortality at 30 and 90 d ( P = 0.001 and P = 0.03). RESULTS: Thirty-day and 90-d mortality was 44% and 58%, respectively. Receiver operating characteristic curve analysis was performed. Short-term mortality was assessed at 30 and 90 d. MELD-Na and Maddrey DFI were calculated on admission. Demographic, clinical and laboratory parameters were obtained. METHODS: We prospectively assessed 52 patients with AH. The bloid thinner will likely raise my INR and temporarily raise my MELD, it's worth a shot if the body breaks up the clot.AIM: To compare the ability of model for end-stage liver disease (MELD)-Na and Maddrey discrimination function index (DFI) to predict mortality at 30 and 90 d in patients with alcoholic hepatitis (AH). Though it increases the risk of bleeding, with weekly monitoring its a risk/reward decision. If my next upper endoscopy – in the next 2 weeks here in Tucson – shows no new varices we may try the blood thinner even with my low platelet counts. I have had esophageal varices banded – 6-8 times (no bleeding so far) – but that has precluded using a blood thinner to allow the body to dissolve the clot on its own. I have venous congestion that is of major concern because if it continues to grow it causes other operative problems. They have me on the "active" list and am in the discussion at their weekly team meetings.
The doctors at Mayo/Phoenix emphasized that the MELD isn't everything as some people are sicker than their scores indicate. I just had my 1year/3 month pre-liver transplant review and my MELD is a 10. There are lots of threads out there with questions and comments about MELD Scores.
0 kommentar(er)
