Diagnostic value of a combined serology-based model for minimal hepatic encephalopathy in patients with compensated cirrhosis / 中华检验医学杂志

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

The value of Fib4 and APRI in predicting liver failure after hepatectomy in patients with hepatocellular carcinoma / 中华肝胆外科杂志

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.

Clinical value of preoperative aspartate aminotransferase-to-platelet ratio index in predicting liver failure after hepatectomy for primary liver cancer / 第二军医大学学报

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.

Clinical significance of serum prealbumin-bilirubin score (PALBI) in predicting posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma / 中华肝胆外科杂志

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.

Correlation between model for end-stage liver disease score and prognosis in mushroom poisoning patients:a multicenter clinical study / 中华危重病急救医学

Objective To find out the clinical indicators related to prognosis in patients with acute mushroom poisoning, and approach its correlation with prognosis. Methods Clinical data of patients with mushroom poisoning admitted to the First Hospital of China Medical University, the Ninth People's Hospital of Shenyang, Xiuyan Central People's Hospital, and Fushun Central Hospital from August 2015 to August 2017 were retrospectively analyzed. The biochemical indicators within 24 hours after admission, sequential organ failure assessment (SOFA) score, model for end-stage liver disease (MELD) score, whether plasmapheresis (PE) was carried out or not and 28-day prognosis of patients were collected. According to prognosis, the patients were divided into death group and survival group, and the differences in above parameters between the two groups were compared. Spearman or Pearson correlation method was used to analyze the relationship between MELD score and prognosis. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of MELD score for prognosis. Further analysis of the patients receiving PE treatment was conducted. Results A total of four Liaoning hospitals with 89 patients with mushroom poisoning were enrolled, with 6 died within 28 days, and 83 survived. There were 17 patients with severely impaired liver and coagulant functions accepted PE treatment, with 6 patients died within 28 days, and 11 survived. ① In 89 patients, compared with survival group, MELD score, prothrombin time (PT), activated partial thromboplastin time (APTT), total bilirubin (TBil), international normalized ratio (INR), blood glucose (Glu), alanine aminotransferase (ALT), γ-glutamyltransferase (GGT) in death group were significantly increased [MELD score: 32.34 (28.31, 41.06) vs. 8.76 (3.77, 21.19), PT (s): 53.5 (52.4, 113.2) vs. 14.5 (13.8, 19.5), APTT (s): 58.6 (48.9, 70.8) vs. 36.9 (34.4, 43.2), TBil (μmol/L): 134.8 (31.3, 155.6) vs. 21.5 (15.1, 41.4), INR: 6.0 (5.6, 14.7) vs. 1.2 (1.1, 1.5), Glu (mmol/L): 9.2 (9.0, 11.0) vs. 6.6 (5.7, 7.8), ALT (U/L):5 923.0 (1 105.0, 6 000.0) vs. 35.0 (18.0, 1 767.0), GGT (U/L): 49.0 (32.0, 57.0) vs. 25.0 (16.0, 41.0), all P < 0.05], but the prothrombin activity (PTA), albumin (ALB), serum Na+, Cl- were significantly decreased [PTA: 13.0% (6.0%, 14.0%) vs. 80.0% (61.0%, 87.0%), ALB (g/L): 31.1 (29.8, 39.0) vs. 42.4 (37.9, 44.3), Na+(mmol/L): 126.5 (122.4, 131.0) vs. 137.0 (134.9, 141.0), Cl- (mmol/L): 93.5 (87.6, 95.0) vs. 104.0 (101.3, 106.0), all P < 0.05]. Spearson correlation analysis showed that MELD score of patients with mushroom poisoning was positively correlated with the 28-day mortality (r = 0.423, P = 0.001). ROC curve analysis showed that the area under ROC curve (AUC) of MELD score for prognosis of patients with mushroom poisoning was 0.926; when the cut-off value was 27.30, the sensitivity was 100%, and the specificity was 84.3%. ② In 17 patients who accepted PE treatment, compared with survival group, the MELD score, TBil, Glu, and ALT in the death group were significantly increased [MELD score: 36.81±5.18 vs. 29.01±5.23, TBil (μmol/L): 145.2±13.9 vs. 93.2±44.0, Glu (mmol/L): 9.1±1.9 vs. 6.0±2.7, ALT (U/L): 5 961.5±44.5 vs. 3 932.9±1 625.7, all P < 0.05], and Cl- was significantly lowered (mmol/L: 94.3±1.2 vs. 100.5±5.7, P < 0.05), but SOFA score showed no significant difference (5.83±2.71 vs. 5.91±1.58, P > 0.05). Correlation analysis showed that the MELD score in patients with mushroom poisoning who accepted PE treatment was positively correlated with 28-day mortality (r = 0.355, P = 0.001), but no correlation with SOFA score was found (r = 0.427, P = 0.087). ROC curve analysis showed that the AUC of MELD score in the prediction of mushroom poisoning patients undergoing PE treatment was 0.545; when the cut-off value was 32.19, the sensitivity was 33.3%, and the specificity was 100%. Conclusions In mushroom poisoning patients, especially those undergoing PE treatment, the higher the MELD score, the higher the mortality is. MELD score could assess the prognosis of patients with acute mushroom poisoning.

Prognostic Value of Model for End-Stage Liver Disease Incorporating with Serum Sodium Score for Development of Acute Kidney Injury after Liver Transplantation / 中华医学杂志(英文版)

<p><b>Background</b>Contribution of model for end-stage liver disease incorporating with serum sodium (MELD-Na) score in predicting acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is yet to be identified. This study assessed the prognostic value of MELD-Na score for the development of AKI following OLT.</p><p><b>Methods</b>Preoperative and surgery-related variables of 321 adult end-stage liver disease patients who underwent OLT in Fuzhou General Hospital were collected. Postoperative AKI was defined and staged in accordance with the clinical practice guidelines developed by Kidney Disease: Improving Global Outcomes. Univariate and multivariate analysis was performed to determine the risk factors for AKI following OLT. The discriminating power of MELD/MELD-Na score on AKI outcome was evaluated by receiver operating characteristic (ROC) curve. Spearman's correlation analysis was used for identifying the correlated relationship between MELD/MELD-Na score and the severity levels of AKI.</p><p><b>Results</b>The prevalence of AKI following OLT was in 206 out of 321 patients (64.2%). Three risk factors for AKI post-OLT were presented, preoperative calculated MELD score (odds ratio [OR] = 1.048, P = 0.021), intraoperative volume of red cell suspension transfusion (OR = 1.001, P = 0.002), and preoperative liver cirrhosis (OR = 2.015, P = 0.012). Two areas under ROC curve (AUCs) of MELD/MELD-Na score predicting AKI were 0.688 and 0.672, respectively; the difference between two AUCs was not significant (Z = 1.952, P = 0.051). The Spearman's correlation coefficients between MELD/MELD-Na score and the severity levels of AKI were 0.406 and 0.385 (P = 0.001, 0.001), respectively.</p><p><b>Conclusions</b>We demonstrated that preoperative MELD score, intraoperative volume of red cell suspension transfusion and preoperative liver cirrhosis were risk factors for AKI following OLT. Furthermore, we preliminarily validated that MELD score seemed to have a stronger power discriminating AKI post-OLT than that of novel MELD-Na score.</p>

Comparison of the Child-Turcotte-Pugh Classification and the Model for End-stage Liver Disease Score as Predictors of the Severity of the Systemic Inflammatory Response in Patients Undergoing Living-donor Liver Transplantation

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-alpha, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.

Evaluation of postoperative short·-term survival rate after liver transplantation for benign end-stage hepatopathy by model for end-stage liver disease score and serum sodium concentration and ascites condition / 中华消化外科杂志

Objective To investigate the efficiency of model for end-stage liver disease(MELD)score,serum sodium concentration and aseites condition in the evaluation of short-term survival rate of patients with benign end-stage hepatopathy after liver transplantation.Methods The clinical data of 98 patients with benign end-stage hepatopathy who had undergone liver transplantation in Fuzhou General Hospital from January 1999 to February 2007 were retrospectively analyzed.The relationship between serum sodium concentration.ascites condition and the prognosis of patients with the same MELD score was analyzed.Kaplan-Meier survival curve was drawn.The 1-year survival rate of the patients was analyzed by chi-square test.The mortality of patients with the same MELD score at the end of the third month after operation was analyzed by Fisher's exact test.Results MELD score of aIJ patients was 15-25 or＞25.The postoperatire 3-month mortality rates of patients with serum sodium concentration≥130 mmol/L were 5%and 15%.which were significantly lower than 33%and 55%of those with serum sodium concentration＜1 30 mmol/L.The difference upon 1-year survival rates between them had statistical significance(x2:12.88,P＜0.05).The postoperative 3-month mortality rates of patients without ascites were 5%and 8%.which were lower than 35%and 57%of those with aseites.and the difference upon 1-year survival rates between them had statistical significance(X2=15.26.P＜0.05).Conclusions It is more accurate to evaluate the short-term survival rate after liver transplantation for benign end-stage hepatopathy by combining the MELD score with serum sodium concentration and ascites condition.