[New scoring systems for severity outcome of liver cirrhosis and hepatocellular carcinoma: current issues concerning the Child-Turcotte-Pugh score and the Model of End-Stage Liver Disease (MELD) score].

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.

[Outbreak of hepatitis by Orientia tsutsugamushi in the early years of the new millenium].

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.