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Objective:To investigate the prognosis value of the Child-Turcotte-Pugh (CTP), pediatrics end-stage liver disease/model for end-stage liver disease(PELD/MELD) and sequential organ failure assessment (SOFA) scores in pediatric acute liver failure (PALF) at 28 th day. Methods:Fifty-four PALF patients admitted in the Pediatric Intensive Care Unit (PICU) and Infection Department of Pediatrics, Qingdao Women′s and Children′s Hospital from June 1, 2012 to June 1, 2019 were included in the study.According to the survival of PALF patients on the 28 th day, they were divided into the survival group (28 cases) and the death group (26 cases). Baseline characte-ristics and laboratory examination data of PALF patients in both groups were collected and compared.Receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of CTP, PELD/MELD and SOFA scores in PALF. Results:The mortality rate of 54 PALF patients was 48.1%.Compared with the survival group, PALF patients in the death group were significantly younger than those in survival group [11.0(3.8-39.0) months vs.14.5(7.3-84.0) months]( Z=-2.145, P=0.020). In addition, CTP, PELD/MELD and SOFA scores were significantly higher in the death group than those in survival group [14.0(11.7-15.0) vs.9.0(7.0-10.0), 32.0(29.0-36.0) vs.25.0(22.0-26.0), 13.0(11.0-16.0) vs.6.0(4.0-7.0)]( Z=-5.095, -4.894, -5.502, all P<0.05). Serum lactate level, blood ammonia level, total bilirubin, direct bilirubin and international normalized ratio were significantly higher in the death group than those in survival group [3.4(2.1-5.3) mmol/L vs.1.5(0.8-2.3) mmol/L, 69.5(46.9-102.9) μmol/L vs.41.7(27.3-50.3) μmol/L, 173.0(97.0-237.2) μmol/L vs.71.9(62.0-136.9) μmol/L, 132.3(53.6-206.2)μmol/L vs.59.3(62.0-99.7) μmol/L, 2.6(1.8-3.5) vs.1.7(1.5-1.9)]( Z=-4.027, -3.220, -2.649, -2.648, -3.807, all P<0.05). Prothrombin time (PT) was significantly prolonged in the death group than that of survival group [27.5(19.2-41.9)s vs.17.8(16.9-22.2)s]( Z=-3.489, P<0.05). Compared with those of survival group, serum albumin, alanine transaminase (ALT) and alpha fetoprotein (AFP) levels were significantly lower in the death group [(30.9±1.0) g/L vs.(33.6±0.9) g/L, 379.2(163.3-880.3) U/L vs.962.5(457.0-1 657.3) U/L, 7.5(0.7-115.8) μg/L vs.22.1(7.9-91.3) μg/L]( t=2.049, Z=-2.510, -2.342, respectively, all P<0.05). The incidence of alimentary tract hemorrhage was significantly higher in the death group than that of survival group (22/26 cases vs.11/28 cases)( χ2=13.340, P<0.05). The cut-off value of CTP, PELD/MELD and SOFA scores in predicting the prognosis of PALF were 11.5, 28.5 and 10.0, respectively.Among the three scoring systems, the specificity and positive predictive value of SOFA scores remained the highest.The sensitivity and specific of a combination of three scoring systems in predicting the prognosis of PALF were 92.3% and 89.3%, respectively, and its Youden index was the highest than that of a single scoring of either CTP, PELD/MELD or SOFA ( Z=2.19, P<0.05). Conclusions:CTP, PELD/MELD and SOFA scores have high predictive value for the short-term prognosis of PALF.The combined detection of the three scoring systems can improve the forecasting efficiency of PALD.
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Background: Liver cirrhosis is one of the most common causes of morbidity and mortality. The availability of liver transplant has stressed on the need for accurate prognostication. Various scoring systems have been developed for the same and studies have been conducted to find the correlation of various biochemical parameters with these.Methods: This is a cross sectional study conducted on 100 patients with stigmata of liver cell failure on clinical examination and substantiated by imaging. Serum Uric acid and other biochemical parameters were determined. Child Turcotte Pugh Score, Model for End Stage Liver Disease (MELD) score, United Kingdom Model for End Stage Liver Disease (UKELD) score was calculated and the correlation obtained.Results: The study showed significant, positive correlation between uric acid level and CTP, MELD and UKELD score. The study also showed the positive correlation of serum uric acid with various biochemical parameters such as total bilirubin, Prothrombin time/ International Normalized Ratio (PT/INR) and serum creatinine and negative correlation with serum albumin, with a significant p value. The mean serum uric acid was found to be 4.79(4.79± 2.0)Conclusions: The study showed a correlation between serum uric acid and the various available scoring systems such as CTP score, MELD and UKELD score. Hence serum uric acid can be used as an alternative prognostic parameter in predicting the severity and prognosis of cirrhosis of liver.
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Objective To evaluate the predictive effect of preoperative CTP score,MELD score and MELD-Na score on short-term prognosis (≤ 3 months) after liver transplantation,to analyze factors which correlated with survival,and to seek indicators that accurately predicted short-term outcomes.Methods The clinical data of 73 consecutive patients with end-stage liver diseases who underwent liver transplantation in a single center were retrospectively analyzed.The area under the ROC curve (AUC) was used to determine the predictive power.Correlated factors were analyzed by multivariate logistic regression.The statistical processing package used was SAS 9.1.3 software.Results 11 (15.1％) of 73 patients died within 3 months after liver transplantation.The areas under the ROC curve of the preoperative CTP score,MELD score and MELD-Na score for predicting short-term survival were 0.817,0.839 and 0.860 respectively.There was no significant difference among these 3 scoring systems.On univariate analysis,indicators significantly correlated with early mortality were preoperative serum sodium,serum urea,PT-INR,CTP score,MELD score and MELD-Na score.On logistic multiple regression,only MELD-Na score remained as a significant indicator (P =0.001,β =-2.496,OR =0.085,95％ CI:0.019 ～ 0.370).Conclusions The MELD-Na scoring system showed superior predictability of early mortality in patients who underwent liver transplantation.The preoperative MELD-Na score was an independent risk factor of short-term survival.The higher the MELD-Na score,the higher was the early mortality.
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Objective To investigate the value of the model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) score in predicting the prognosis of patients with liver cirrhosis.Methods Seventy patients with liver cirrhosis were selected.The MELD and CTP score before surgery was calculated and was analyzed the correlation between the two models was analyzed.The prognosis ability by the area under the receiver operating characteristic (ROC) curve was evaluated.Results Twenty three cases (32.9％,23/70) appeared post operative serious complication.The scores of MELD and CTP in complication group (23 cases) was (19.58 ±5.90),(8.84 ± 1.87) scores,the scores of MELD and CTP in without complication group (47 cases) was ( 12.27 ± 2.94),(6.10 ± 1.12) scores,there were significant differences between two groups (P ＜ 0.01 ).According to the MELD score,70 patients was divided into ＜ 14 scores group(30 cases),14 - 23 scores group(28 cases),＞ 23 scores group( 12 cases),the rate of complication was 10.0％(3/30),35.7％( 10/28 ) and 83.3％(10/12),there were significant differences among three groups(P＜ 0.05).According to the CTP score,70 patients were divided into A grade(29 cases),B grade (25 cases) and C grade( 16 cases),the rate of complication was 10.3％ ( 3/29 ),36.0％ (9/25) and 68.8％ ( 11/16 ),there were significant differences among three groups (P ＜ 0.05 ).The results of Pearson correlation analysis showed that the MELD score and CTP score had significant correlation (r =0.874,P ＜ 0.01 ).The area under the ROC curve of the MELD score and CTP score in prognosis the perioperative complication was 0.877 (95％ CI:0.84 - 0.95 ) and 0.852 (95％ CI:0.83 - 0.94),there was no significant difference ( U =0.157,P ＞ 0.05 ).Conclusion Both MELD and CTP score can accurately predict the short term prognosis of patients with liver cirrhosis.
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BACKGROUND: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). METHODS: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). RESULTS: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). CONCLUSIONS: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation.
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Humans , Anesthesia , Anesthesia, General , Autonomic Nervous System , Baroreflex , Blood Pressure , Cytidine Triphosphate , Electrocardiography , Heart Rate , Heart , Hemodynamics , Liver Cirrhosis , Liver Transplantation , Liver , ReflexABSTRACT
It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.