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Objective:To evaluate the value of preoperative aspartate aminotransferaseto platelet ratio index (APRI) and fibrosis index 4 (Fib4) in predicting posthepatectomy liver failure (PHLF) of primary hepatocellular carcinoma.Methods:The data of 587 patients with hepatocellular carcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2020 were retrospectively collected and analyzed, including 412 males and 175 females, aged (56.8±11.2) years. Univariate and multivariate logistic regression were used to analyze the influencing factors of PHLF. The ability of Child-Pugh score, model for end-stage liver diseas (MELD) score, APRI and Fib4 to predict PHLF was evaluated through the receiver operating characteristic (ROC) curve of subjects.Results:Among 587 patients, 186 (31.7%) had liver failure after hepatectomy. In multivariate logistic regression analysis, APRI ( OR=2.660, 95% CI: 1.314-5.384, P=0.007) and Fib4 ( OR=1.322, 95% CI: 1.157-1.511, P<0.001) were risk factors for PHLF in patients with hepatocellular carcinoma. The higher the number, the greater the risk of PHLF. The predicted area under the ROC curve of PHLF in patients with hepatocellular carcinoma was Fib4(0.719)>APRI(0.686)>MELD score(0.618)>Child-Pugh score(0.565). Conclusion:APRI and Fib4 were risk factors of PHLF in patients with hepatocellular carcinoma. They predict the occurrence of PHLF better than Child-Pugh score and MELD score.
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Anxiety and depression were interlinked with the severity of liver diseases. Patients should know the true severity ofthe disease and patient counseling helps them. This was a cross-sectional study carried out on 100 patients sufferingfrom chronic liver disease. Child Turcotte Pugh score was used to calculate the severity of the disease. HospitalAnxiety and Depression Scale was used to calculate the anxiety and depression of patients. Non-parametric tests areused to find out the association. The level of significance was p < 0.05. The mean age group of patients was 47.29± 13.17 years. The three most presenting clinical signs and symptoms according to their occurrence was abdominalpain (74%), edema (58%), and ascites (51%). The median Child Turcotte Pugh score was 9 corresponds to class B.We observed highly significant association (p < 0.01) between total bilirubin (p < 0.0001), albumin (p < 0.0001),and the severity and prognosis of the disease. We observed a higher percentage of patients with borderline abnormalanxiety (61%) and depression (51%) in our study. High-risk patients were made aware of the severity of the diseaseand consequences thereafter, provided with patient counseling along with a list of deaddiction centers. Integrating apsychologist can benefit patients struggling with deaddiction of alcohol.
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Liver plays a central role in the maintenance of haemostasis. Impairment of liver parenchymal cell function disturbs haemostasis resulting in the development of multiple coagulation abnormalities. We wanted to study the coagulation profile and haemostatic dysfunction in liver disease patients so as to prevent bleeding related complications and evaluate the relationship between bleeding tendencies and coagulation profile abnormalities in such patients.METHODSThis was a cross sectional study conducted in the Department of Pathology, JNMC, A.V.B.R.H, Sawangi, Wardha, from August, 2017 to July 2019 among 102 patients of liver diseases. PT, D-dimer, and platelet count were assessed in different liver diseases. Data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of <0.05 was considered statistically significant.RESULTSA total of 102 patients were included in the study. Mean age of the patients was 40.07 ± 15.21 years. 69.61% patients were males. Fever with abdominal distension was the most common complaint. Mean with SD of Child Pugh score was 8.31±2.3 and Mean with SD of MELD score was 13.1±8.24. For predicting cirrhosis and other chronic liver disorders, out of all coagulation parameters, D-Dimer showed the best diagnostic accuracy.CONCLUSIONSPresent study showed an overall good diagnostic power of coagulation parameters in assessing different liver diseases and also showed that D-dimer may be regarded as a stable and good predictor for chronic liver diseases.
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Introduction: Esophageal varices are generally the mostcommon clinical manifestation of portal hypertension inPatients of liver cirrhosis. Most common causes of deathin liver cirrhosis are hemorrhage from esophageal varices.The present study has been carried out to identify clinical,biochemical and ultrasonographic parameters which mightnon‑invasively predict the existence and the risk of varicealbleed.Material and Methods: The present prospective observationalstudy was conducted in 2 years among 100 patients sufferingfrom liver cirrhosis above 18 years of age. Detailed history,clinical examination, investigations to fulfill the inclusionand exclusion criteria of all patients was taken. Different nonendoscopic parameters were taken Plateletcount, Coagulationprofile, Ultrasonography whole abdomen, Child-PughTorcotte (CPT) Score, AST to platelet ratio index (APRI) forthe detection of esophageal varices and its grading in livercirrhosis patients which was confirmed by endoscopy.Results: There was significant association of presence ofesophageal varices in liver cirrhosis patients with presence oficterus, presence of ascites,presence of splenomegaly, gradeof Child Pugh Score, AST to Platelet rationdex (APRI score)Prothrombin Time and International Normalized Ratio(PT/INR), mean TB (mg/dl), mean spleen size.Conclusions: The result of present study concluded thatsome parameters are strongly associated with grades ofvarices and could be useful for early detection and subsequentmanagement of varices.
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Background: Liver cirrhosis is the end result of chronic liver injury and is one of the most common cause of morbidity and mortality. Several scorings are available to predict the severity and prognosis of liver cirrhosis. This study aims to calculate APRI index, MELD score and child Pugh score in cirrhosis patients and to find the correlation between them.Methods: This is the Cross-sectional study on 100 patients confirmed with cirrhosis of liver. Cirrhosis due to alcohol, Hepatitis B and C, autoimmune, Cryptogenic, NAFLD, were included in the study. APRI Index, MELD Score and Child Pugh Score were calculated, and the correlation was obtained.Results: This study found out the relationship between APRI index, MELD Score and Child Pugh Score with significant p value. The study also showed that all the three scores were raised with patients who had complication of cirrhosis like encephalopathy, refractory ascites. Among those who had complication like grade 3 or 4 encephalopathy, APRI index had a mean value of 3.4, Child Pugh had a mean score of 13.2, and MELD had a mean score of 36.08 with standard deviation of 2.0, 1.5, 6.0 respectively.Conclusions: APRI index is an independent predictor of morbidity and mortality. The prognostic performance of all 3 was comparable, Hence APRI index can be used as an alternative scoring which is cost effective and objective method in predicting the severity and prognosis in cirrhosis of liver.
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Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett抯 formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(�.97), Class B=437.35(�.60), Class C=479.71(�.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.
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@#Cirrhotic cardiomyopathy is a recognised complication of liver cirrhosis and predicts poor outcomes. Detection of diastolic dysfunction, an early indicator of left ventricular dysfunction can help identify those patients at risk of disease progression. In our study we showed that there was a high prevalence of diastolic dysfunction amongst patients with liver cirrhosis at our outpatient clinic, with the majority being Child-Pugh A/low MELD score. Multiple regression analysis indicated that age and sodium levels were significantly associated with the presence of diastolic dysfunction. This further reinforces the importance of dietary sodium restriction amongst patients with liver cirrhosis.
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Introduction: The model for end-stage liver disease (MELD)score is a useful tool to assess prognosis in critically illcirrhotic patients. Therefore present study’s aim is to evaluateprognostic value of MELD score in patients with cirrhosis andto find out the correlation of MELD score with Child-PughScore.Material and Methods: Present study was carried out ina large public hospital in Mumbai from October 2003 toNovember 2004 on liver cirrhosis patients. Seventy sixpatients of cirrhosis of liver who had attended gastroenterologyoutpatient department of the hospital were included in thestudy. Thirty age and sex matched healthy controls wereincluded in the study. MELD score was calculated at Mayoclinic calculator site.Results: Mean age of cases of cirrhosis was 46.97 + 12.96years with range of 15-74 years. There was no significantdifference in the age or sex distribution of cases in the survivalor expired category (p>0.05). Our study showed significantdifference in mortality between the three Child Pugh grades(p<0.05). Present study showed significant correlationbetween MELD score and Child-Pugh Score. Mean MELDscore was significantly more in expired cases (22.0+7.74)than in survived cases (14.87+6.42) during six monthlyfollow up period (p<0.05).Cases with MELD scores ≥30 hadsignificantly high mortality rate.Conclusion: Therefore MELD score can be used as significantshort term prognostic factor in patients with cirrhosis.
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Introduction: Chronic liver disease is a disorder in whichprogressive destruction of liver parenchyma leads to fibrosisand lead to cirrhosis. Increased level of serum uric acid may because insulin resistance, metabolic syndrome and oxidativestress which are the risk factors for progression of liverdisease.Objective: To estimate the levels of uric acid and evaluate itsassociation with the severity of liver disease.Methods: One hundred fifty patients diagnosed with Chronicliver disease, age between 20 to 65 years, either gender, wereenrolled in the study. Patients were grouped as classes A, Band C on the basis of Child Pugh score. Serum uric acid wasestimated and compared among the three groups.Result: Analysis of Variance (ANOVA) was applied and it wasobserved that there was a significant elevation of serum uricacid level with the progression of disease (P = <0.001). Apositive association of uric acid on applying Spearman’scorrelation, with progression of Child Pugh score was alsoobserved (r = 0.293; P = <0.001)
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Background: Cirrhosis of liver is considered as chronicdisease of liver characterised by the triad of parenchymalinflammation, necrosis and regeneration with diffuse increasein fibrosis and formation of nodules around regenerating liverparenchyma. A retrospective study of 90 patients of livercirrhosis visiting OPD/Indoor of SGRDIMSR, Vallah, SriAmritsar were included in the study conducted from Jan 2017to Aug 2018 to assess QTc interval in patients with cirrhosis ofliver due to any etiology and to find the correlation betweenQTc interval and severity of liver cirrhosis as per Child-PughScore.Methods: The severity of liver cirrhosis was assessed andaccording to the Child Pugh Score, divided into Class A, ClassB and Class C of 30 patients each. QT interval was noted in allthe patients. QTc was calculated by Bazett’s formula. Fromabove parameters we try to find out whether there is anycorrelation between QTc and severity of disease.Results: The mean value of calculated QTc interval in: ClassA=0.474; Class B=0.490 and Class C=0.583. The QTc intervalincreased linearly with the severity of the disease and the pvalue was less than 0.001 which is highly significant.Conclusion: In our study we concluded that the prolongationof QTc interval is co-related with liver function and itsprevalence increases with the severity of liver dysfunction.Prolongation of the QTc interval was statistically confirmed inChild-Pugh C and B. The prolonged Q-T interval predictssevere arrhythmias and sudden death, and they are the idealcandidates for liver transplantation.
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Objective To explore the predictive value of preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for post-hepatectomy liver failure (PHLF) after hepatectomy in the patients with primary liver cancer (PLC). Methods A retrospective study was conducted on the data from the PLC patients who underwent first hepatectomy in Tumor Hospital Affiliated to Guangxi Medical University between Sep. 2013 and Dec. 2016. The logistic regression model and receiver operating characteristic (ROC) curve were performed to determine the predicting values of APRI, Child-Pugh score, model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score for PHLF. Results A total of 1 108 PLC patients were included in this study, and PHLF occurred in 217 (19.58%) patients. The logistic regression analysis showed that Child-Pugh score, MELD score, ALBI score and APRI were predicting factors for PHLF (all P0.05). The ROC curve analysis showed that preoperative APRI (area under curve [AUC]: 0.745, 95% confidence interval [CI] 0.709-0.781, P0.001) was significantly better for predicting PHLF compared with Child-Pugh score (AUC 0.561, 95% CI 0.516-0.605, P＝0.005), MELD score (AUC 0.650, 95% CI 0.610-0.691, P0.001) and ALBI score (AUC 0.662, 95% CI 0.621-0.703, P0.001). Based on Youden index, the best cut-off value of preoperative APRI was 0.55 for predicting PHLF in PLC patients, with a sensitivity of 71.9% and a specificity of 68.5%, and the patients with APRI0.55 had significantly higher overall incidence of PHLF, and higher incidence of PHLF A, B and C compared with ones with APRI≤0.55 (all P0.05). Conclusion Preoperative APRI is more accurate for predicting PHLF after hepatectomy in PLC patients versus the Child-Pugh, MELD and ALBI scores, providing guiding significance for clinical treatment of PLC.
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Background: Chronic liver disease (CLD) is a major cause of morbidity. In CLD high plasma glucose and HbA1c level are independently associated with severe disease and poor prognosis. The Child Pugh scoring is still the corner stone in prognostic evaluation of CLD patients. Aims & Objectives: The aim of this study was to evaluate plasma glucose (FBS, PPBS) & glycosylated haemoglobin (HbA1c) in patients with CLD and calculate the Child-Pugh score for each patient and correlate with each other. Methods: It was a cross sectional,observational hospital based study consisted of 100 patients with CLD whose FBS,PPBS and HbA1C were measured & it was correlated with Child-Pugh score. Results: There was significant association between impaired FBS & impaired OGTT &PPBS with the severity of CLD (p - 0.0487& 0.0476). However HbA1c & its correlation with Child Pugh score showed no significance (p- 0.142) but incidence of death with raised plasma glucose & with raised HbA1c were significant ( p - 0.043 & 0.042). Conclusion: Incidence of impaired FBS, OGTT & PPBS were more in-patient with CLD, which may be considered as prognostic marker for the severity of CLD. Impaired blood gucose may also adversely affect outcome of CLD& therefore, blood glucose should be determined in every CLD patients. Early detection & management can improve the overall outcome of CLD patients.
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Objective To study the value of serum prealbumin-bilirubin score (PALBI) in predicting posthepatectomy liver failure (PHLF) for patients with HBV related hepatocellular carcinoma (HCC).Methods A retrospective study was conducted on 919 HBV-related HCC patients who underwent hepatectomy from September 2013 to December 2016 at the Affiliated Tumor Hospital of Guangxi Medical University.These patients were divided into a training cohort (n =689) and a validation cohort (n =230) using the 3 ∶ 1 matching principle.The training cohort was divided into the control group (n=546) and the PHLF group (n=143) according to whether PHLF occurred.The multivariate logistic regression model was used to analyze the factors related to PHLF in the training cohort,and then the PALBI score was established.The ability of the PALBI score to predict PHLF was evaluated by the area under the receiver operating characteristic curve (AUC) and compared with the Child-Pugh,model for end-stage liver disease (MELD),and albumin-bilirubin (ALBI) scores.Results Univariate and multivariate logistic regression analyses showed the factors including HBV-DNA≥ 103 IU/ml,total bilirubin,prealbumin,platelet count,AST,prothrombin time,intraoperative blood loss ≥400 ml and major liver resection were closely related to PHLF.The ability of the PALBI score (AUC =0.733) to predict PHLF preoperatively was superior to the ChildPugh score (AUC =0.562),the MELD score (AUC =0.652) and the ALBI score (AUC =0.683) in the entire training cohort.Similar results were obtained in the entire validation cohort (AUC:0.752 vs.0.599 vs.0.641 vs.0.678).To eliminate the effect of a small residual liver volume on PHLF,the ability of each of these scores in the training and validation cohorts to predict PHLF was calculated respectively in these 2 cohorts of patients who underwent only minor liver resection,and similar results were obtained.Conclusion The PALBI score was significantly superior to the Child-Pugh,MELD and ALBI scores in predicting PHLF in patients with HBV-related HCC who underwent liver resection.The PALBI score is a simple,non-invasive and reliable novel model in predicting PHLF.
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BACKGROUND/AIMS: The aim of this study was to investigate parameters that predict radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to identify the clinical significance of RILD. METHODS: We retrospectively reviewed the medical records of 117 HCC patients who were treated by SBRT from March 2011 to February 2015. RILD was defined as elevated liver transaminases more than five times the upper normal limit or a worsening of Child-Pugh (CP) score by 2 within 3 months after SBRT. All patients were assessed at 1 month and every 3 months after SBRT. RESULTS: Median follow-up was 22.5 months (range, 3 to 56) after SBRT. RILD was developed in 29 of the 117 patients (24.7%). On univariate analysis, significant predictive factors of RILD were pretreatment CP score (p < 0.001) and normal liver volume (p = 0.002). Multivariate analysis showed that CP score was a significant predictor of RILD (p < 0.001). The incidence of RILD increased above a CP score of 6 remarkably. The rate of recovery from RILD decreased significantly above a CP score of 8. Survival analysis showed that CP score was an independent prognostic factor of overall survival (p = 0.001). CONCLUSIONS: CP score is a significant factor to predict RILD in patients with chronic liver disease. RILD can be tolerated by patients with a CP score ≤ 7. However, careful monitoring of liver function is needed for patients with a CP score 7 after SBRT.
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Humans , Carcinoma, Hepatocellular , Follow-Up Studies , Incidence , Liver Diseases , Liver , Medical Records , Multivariate Analysis , Radiosurgery , Retrospective Studies , TransaminasesABSTRACT
Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.
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Background:Child-Pugh score(CPS)and albumin-bilirubin(ALBI)score have important predictive value for the assessment of survival of patients with hepatocellular carcinoma(HCC). Aims:To investigate the predictive values of CPS and ALBI score for radiation-induced liver disease(RILD)and long-term prognosis in patients with HCC receiving stereotactic ablative radiotherapy(SABR). Methods:A total of 152 HCC patients receiving SABR from June 2006 to June 2012 at Baoji Central Hospital were enrolled. CPS and ALBI score were determined,and the predictive values of CPS and ALBI score for RILD and prognosis were compared. Results:In 152 patients with HCC,CPS-A was noted in 119 patients, CPS-B in 33 patients;ALBI-1 was noted in 60 patients,ALBI-2 in 86 patients,ALBI-3 in 6 patients. The 5-year overall survival rate was significantly higher in CPS-A patients than in CPS-B patients(46.2% vs. 15.2%,P <0.001). Significant difference in 5-year overall survival rate was found among patients with ALBI-1,ALBI-2 and ALBI-3(P =0.002). CPS grade(HR=1.38,95% CI:1.18-1.94,P=0.008)and ALBI grade(HR=1.68,95% CI:1.32-2.03, P=0.003)were independent risk factors for 5-year survival of patients with HCC. RILD was found in 20 cases(13.8%) within 4 months after SABR. AUC of ALBI for prediction of RILD was significantly higher than that of CPS(0.784 vs. 0.611,P=0.028). Patients with CPS-A and ALBI< -2.76 were less likely to develop RILD after SABR(2.4%). Conclusions:ALBI can effectively predict the occurrence of RILD and long-term survival of HCC patients after SABR.
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Objective To evaluate the feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis,portal hypertension,and severe hypersplenism or after the first gastroesophageal variceal hemorrhage (GEV bleeding).Methods From January 2010 to January 2017,the clinical data from patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding were retrospectively analyzed.These patients underwent splenectomy and pericardial devascularization at the Huashan Hospital Affiliated to the Fudan University.The safety and effectiveness of surgery,postoperative complications and mortality were further explored.Results Liver protection treatment was given before surgery to improve the liver function.Of the 32 patients who underwent splenectomy and pericardial devascularization,the operation time was (2.2±0.3) hours.The blood loss was (208.0± 102.0) ml and the hospital stay after surgery was (11.8±2.8) d.Postoperative complications included fever,wound infection and ascites.One patient died of hypovolemic shock and acute renal failure.The incidence of postoperative PVT was 12.5％ (4/32).The rates of GEV rebleeding at 1 year,3 years,and 5 years after surgery were 6.3％ (2/32),6.3％ (2/32),and 9.4％ (3/32).The 5-year overall mortality rate was 12.5％ (4/32).Conclusions In the absence of obvious surgical contraindications and with a lack of donor livers for liver transplantation,aggressive perioperative management,splenectomy and pericardial devascularization are a feasible option for patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding.
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Objective To compare the discriminatory power of the Albumin-bilirubin score (ALBI) and the Child-Pugh score (CP) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after curative liver resection,and to explore the clinical value of ALBI score.Methods The clinical data of HCC patients who underwent curative hepatectomy in Nanfang Hospital,Southern Medical University from January 2011 to December 2016 were retrospectively reviewed.The risk factors of PHLF were identified through logistic regression.The areas under the receiver operating characteristic (ROC) curve were calculated to measure the ALBI and CP scores in the prediction of PHLF.Results A total of 1 013 patients were enrolled.The incidence of PHLF was 17.7％ (179/1013).Both CP score (OR =1.94,P ＜ 0.05) and ALBI score (OR =3.85,P ＜ 0.05) were identified as independent predictors of PHLF on multivariable analysis.The incidence of PHLF in patients with CP grade A was significantly lower than those with CP grade B(16.4％,158/963 vs.42％,21/50;P ＜ 0.05).The incidences of PHLF in patients with AIBI 1,2 and 3 were 9.9％ (50/504),24.8％ (124/501) and 62.5％ (5/8),respectively (P ＜0.05),indicating that the incidences of PHLF increased significantly with increasing ALBI grades.Moreover,when the ALBI score further classified patients of the CP grade A into the ALBI 1-A and ALBI 2-A subgroups,the incidence of PHLF in patients with ALBI 1-A was significantly lower than that with ALBI 2-A (9.9％,50/504 vs.23.5％,108/459;P ＜0.05).The area under the ROC curve for the ALBI score in predicting PHLF was greater than that of the CP score (0.705 vs.0.630;P ＜ 0.05).Conclusions The prognostic power of the ALBI score was greater than that of the CP score in predicting PHLF.Even in patients with CP grade A,the ALBI score was more sensitive in identifying patients with a high risk of PHLF.The ALBI score is a useful tool to predict PHLF after hepatectomy in HCC patients.
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Background: It has been a great challenge for the physician to predict the prognosis and outcome of the chronic liver disease. Child-Pugh and MELD scores have been a widely used method for the assessment of prognosis in liver cirrhosis. Both used to determine the need for transplantation and also used to determine the effect of treatment on liver function. The combination of Child-Pugh and MELD score can guide patients and surgeons regarding operative risks. Aim and objective: To study and compare the clinical outcomes of patients with liver disease as predicted by Child – Pugh Scoring system, MELD Scoring system, to evaluate the prognostic accuracy of both (Child-Pugh Scoring System and MELD Scoring System). Materials and methods: The study was carried out at Vinayaka Mission’s Medical College and Hospital, Karaikal among the patient population of the medicine ward who were diagnosed as having the chronic liver disease. This included 75 adult patients with the chronic liver disease who were either inpatients or those who reported for follow up as outpatients who were being managed on an ambulatory basis. All the selected patients were subjected to two scoring systems namely Child-Pugh Scoring and MELD Scoring Systems. The two scores derived from applying both the scoring system on each patient were compared and studied for predictive value and prognostic accuracy. S. Arun Kumar, Babu Rajendran, S.R Charu Nagarjun, Sakthivel V. Predicting the prognosis of chronic liver disease: A comparision between Child – Pugh score and Model for end stage liver disease (MELD). IAIM, 2018; 5(3): 71-76. Page 72 Results: In our study, Correlation between Chid-Pugh Score and survival was -0.56 and correlation between MELD score and survival were -0.64. The following diagnostic indices were obtained: Child-Pugh Score: Sensitivity: 42%, Specificity: 78%. MELD Score: Sensitivity: 62%, Specificity: 87.5%. It was well observed that both scoring systems predict clinical outcome well, both scoring systems can be used to prognosticate survival in patients with Chronic Liver disease. However, it appeared that MELD Score is more accurate than the Chid-Pugh score for prognostic purposes. Conclusion: Pearson’s Coefficient of correlation is closer to -1 for MELD Score as compared to Child-Pugh Score. MELD Score has a higher sensitivity and a higher positive predictive value as compared to Child-Pugh score. Hence MELD Score is a better and more accurate clinical scoring system for Chronic liver disease as compared to Child-Pugh score.
ABSTRACT
Background: Hepatorenal syndrome is the development of renal failure in patients with advanced liver cirrhosis, occasionally fulminant hepatitis, who have portal hypertension and ascitis in the absence of some other kidney disease. Objective: To study the clinical profile of hepatorenal syndrome. Methods: All patients of chronic liver disease with renal involvement were studied and patients fulfilling the criteria of hepatorenal syndrome were recruited in the study. The etiology, clinical presentation, morbidity and outcome of patients were recorded. Various variables were studied between survivor group and non survivor group to detect possible predictors of non survival in hepatorenal syndrome. The data was analyzed using SPSS software. Results: 42 patients of hepatorenal syndrome were clinically evaluated. 95% were males and 5% females with mean age of 50.29±8.87 in survivor group and 45.92±10.1 in non survivor group. High level of serum bilirubin, hepatic encephalopathy, decreased level of albumin, hyponatremia and coagulopathy were significant in non survivor group as compared to survivor group. Conclusion: The poor prognostic factors were found to be ascites, severe jaundice, hepatic encephalopathy, alcohol abuse, hypoalbuminemia, progressive renal failure and child pugh score greater than 10. Thus hepatorenal syndrome is decompensated cirrhosis which needs judicious treatment especially using terlipressin and albumin.