MELD SKOR KAO PREDIKTOR MORTALITETA KOD BOLESNIKA SA DEKOMPENZOVANOM ALKOHOLNOM CIROZOM JETRE I RAZVIJENOM HEPATIČNOM ENCEFALOPATIJOM
Sažetak
Ciroza je završni stadijum brojnih hroničnih bolesti jetre. Bolest najčešće nastaje usled hroničnog konzumiranja alkohola i infekcije virusima hepatitisa C i B. U svetu od posledica unosa alkohola godišnje umre više od tri miliona ljudi. Prognostički skorovi razvijeni su sa ciljem procene preživljavanja. Prilikom prognoze kratkoročnog preživljavanja bolesnika sa dekompenzovanom cirozom jetre danas se koristi MELD (engl. Model for End-stage Liver Disease) skor.
Ova prospektivno/retrospektivna studija sprovedena je na uzorku od 56 bolesnika (52 muškarca i četiri žene), čija je prosečna starost bila 55,23 ± 10,82 godine. Vrednosti MELD skora računate su na kraju hospitalizacije i bile su u korelaciji sa definisanim ishodima lečenja. Sprovedena ROC (engl. Receiver operating characteristic) analiza pokazala je da su cut-off vrednosti MELD skora preko 23,5 bile statistički značajne u prognozi mortaliteta. U ukupno ispitivanoj populaciji, preminulo je 72% bolesnika sa skorom većim od dobijene cut-off vrednosti. Ukupan broj bolesnika sa razvijenom hepatičnom encefalopatijom bio je 34 (61%); od toga, preminulo je njih 23. ROC analizom u grupi bolesnika sa hepatičnom encefalopatijom utvrđena je cut-off vrednost MELD skora 30,5, što se statistički signifikantno ne razlikuje od cut-off vrednosti MELD skora za preživljavanje. Odnos muškog i ženskog pola u poduzorcima preminulih i preživelih bolesnika u ovom istraživanju bio je skoro ujednačen.
Cut-off vrednost MELD skora pokazala se kao statistički značajna u prognozi kratkoročnog preživljavanja. Zabeležen porast cut-off vrednosti MELD skora kod bolesnika sa hepatičnom encefalopatijom nije bio statistički značajan. U grupi bolesnika sa hepatičnom encefalopatijom zabeležen je smrtni ishod kod 92% bolesnika, premda nije utvrđeno statistički signifikantno povećanje cut-off vrednosti MELD skora.
Reference
Aiello FI, Bajo M, Marti F, Gadano A, Musso CG. Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns. AME Medical Journal 2017; 2: 174. [CrossRef]
Aiello FI, Bajo M, Marti F, Gadano A, Musso CG. Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns. AMJ 2017;11(2). [CrossRef]
Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR. Underestimation of liver-related mortality in the United States. Gastroenterology 2013; 145(2): 375-82. [CrossRef] [PubMed]
Bajaj JS, O'Leary JG, Tandon P, Wong F, Garcia-Tsao G, Kamath PS et al. Hepatic Encephalopathy Is Associated With Mortality in Patients With Cirrhosis Independent of Other Extrahepatic Organ Failures. Clin Gastroenterol Hepatol 2017; 15(4): 565-74. [CrossRef] [PubMed]
Becker U, Deis A, Sørensen TI, Grønbaek M, Borch-Johnsen K, Müller CF, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology 1996; 23(5): 1025–9. [CrossRef] [PubMed]
Bellentani S, Saccoccio G, Costa G, Tiribelli C, Manenti F, Sodde M et al. Drinking habits as cofactors of risk for alcohol induced liver damage. Gut 1997; 41(6): 845–50. [CrossRef] [PubMed]
Bjerring PN, Gludd LL. Severe hepatic encephalopathy is an independent predictor of mortality in hospitalised patients with cirrhosis Peter N. AME Med J 2017: 2. [CrossRef]
Chen SH, Wan QS, Wang T, Zhang KH. Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis. Biomed Res Int 2020: 2020:7170457. [CrossRef] [PubMed]
Crespin J, Nemcek A, Rehkemper G, Blei AT. Intrahepatic portal-hepatic venous anastomosis: a portal-systemic shunt with neurological repercussions. Am J Gastroenterol 2000; 95(6): 1568-71. [CrossRef] [PubMed]
D’Amico G, Garcia-Tsao G, Pagliaro. L. Natural history and prognostic indicators of survival in cirrhosis: a systematic, review of 118 studies. J Hepatol 2006; 44(1): 217-31. [CrossRef] [PubMed]
Deutsch M, Emmanuel T, Koskinas J. Autoimmune Hepatitis or Wilson’s Disease, a Clinical Dilemma. Hepat Mon 2013; 13(5): e7872. [CrossRef] [PubMed]
Elzouki AN, Suliman S, Alhasan R, Abdullah A, Othman M, Badi A. Predicting mortality of patients with cirrhosis admitted to medical intensive care unit: an experience of a single tertiary center. Arab J Gastroenterol 2016;17(4): 159–63. [CrossRef] [PubMed]
European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012; 57(2): 399-420. [CrossRef] [PubMed]
Francoz C, Glotz D, Moreau R, Durand F. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol 2010; 52(4): 605-13. [CrossRef] [PubMed]
Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. Results of the first year of the new liver allocation plan. Liver Transpl 2004; 10(1): 7-15. [CrossRef] [PubMed]
Ge PS, Runyon BA. Treatment of Patients with Cirrhosis. N Engl J Med 2016; 375(8): 767-77. [CrossRef] [PubMed]
Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 2007; 13(1): 30-7. [CrossRef] [PubMed]
Innes HA, Hutchinson SJ, Barclay S, Cadzow E, Dillon JF, Fraser A et al. Quantifying the fraction of cirrhosis attributable to alcohol among chronic hepatitis C virus patients: implications for treatment cost-effectiveness. Hepatology 2013; 57(2): 451-60. [CrossRef] [PubMed]
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33(2): 464–70. [CrossRef] [PubMed]
Kim WR, Brown Jr RS, Terrault NA, El-Serag H. Burden of liver disease in the United States: summary of a workshop. Hepatology 2002; 36(1): 227–42. [CrossRef] [PubMed]
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095-128. [CrossRef] [PubMed]
Lv GC, Yao JM, Yang YD, Zheng L, Sheng JF, Chen Y et al. Efficacy of combined therapy in patients with hepatitis B virus-related decompensated cirrhosis. World J Gastroenterol 2013; 19(22): 3481-6. [CrossRef] [PubMed]
Maheshwari A, Thuluvath PJ. Cryptogenic cirrhosis and NAFLD: are they related? Am J Gastroenterol 2006; 101(3): 664-8. [CrossRef] [PubMed]
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31(4): 864–71. [CrossRef] [PubMed]
Musso CG, Jauregui JR, Macías Núñez JF. Frailty phenotype and chronic kidney disease: a review of the literature. Int Urol Nephrol 2015; 47(11): 1801-7. [CrossRef] [PubMed]
Myers RP, Shaheen AA, Aspinall AI, Quinn RR, Burak KW. Gender, renal function, and outcomes on the liver transplant waiting list: Assessment of revised MELD including glomerular filtration rate. J Hepatol 2011; 54(3): 462-70. [CrossRef] [PubMed]
National Institute on Alcohol Abuse and Alcoholism. Alcohol Use in the United States 2022. Available from: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
Naveau S, Perlemuter G, Balian A. [Epidemiology and natural history of cirrhosis]. Rev Prat 2005; 55(14): 1527-32. [PubMed]
Olthoff KM, Brown Jr RS, Delmonico FL, Freeman RB, McDiarmid SV, Merion RM et al. Summary report of a national conference: evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA. Liver Transpl 2004; 10(10 suppl 2): A6–22. [CrossRef] [PubMed]
Osna NA, Donohue TM, Kharbanda KK. Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res 2017; 38(2): 147-61. [PubMed]
Pagliaro L. MELD: the end of Child-Pugh classification? J Hepatol 2002; 36(1): 141-2. [CrossRef] [PubMed]
Peeraphatdit T, Naksuk N, Thongprayoon C, Harmsen WS, Therneau TM, Ricci P, et al. Prognostic Value of Model for End-Stage Liver Disease Score Measurements on a Daily Basis in Critically Ill Patients With Cirrhosis. Mayo Clin Proc 2015; 90(9): 1196-1206. [CrossRef] [PubMed]
Pessione F, Ramond MJ, Peters L, Pham BN, Batel P, Rueff B, et al. Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence. Liver Int 2003; 23(1): 45–53. [CrossRef] [PubMed]
Porte RJ, Lisman T, Tripodi A, Caldwell SH, Trotter JF. The International Normalized Ratio (INR) in the MELD score: problems and solutions. Am J Transplant 2010; 10(6): 1349-53. [CrossRef] [PubMed]
Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METaViR, CLINIVIR, and DOSVIRC groups. Lancet 1997; 349(9055): 825–32. [CrossRef] [PubMed]
Rehm J, Dawson D, Frick U, Gmel G, Roerecke M, Shield KD, et al. Burden of disease associated with alcohol use disorders in the United States. Alcohol Clin Exp Res 2014; 38(4): 1068–77. [CrossRef] [PubMed]
Ruf AE, Yantorno SE, Descalzi VI, Andriani OC, Podesta LG, Villamil FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone: a singlecenter experience. Am J Transplant 2004; 4(8): 438. [CrossRef] [PubMed]
Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A et al. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004; 40(6): 897–903. [CrossRef] [PubMed]
Stewart CA, Malinchoc M, Kim WR, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl 2007; 13(10): 1366-71. [CrossRef] [PubMed]
Stickel F, Datz C, Hampe J, Bataller R. Pathophysiology and Management of Alcoholic Liver Disease: Update 2016. Gut Liver 2017; 11(2): 173-88. [CrossRef] [PubMed]
Vaa BE, Asrani SK, Dunn W, Kamath PS, Shah VH. Influence of serum sodium on MELD-based survival prediction in alcoholic hepatitis. Mayo Clin Proc 2011; 86(1): 37-42. [CrossRef] [PubMed]
Veldt BJ, Lainé F, Guillygomarc’h A, Lauvin L, Budjema K, Messner M, et al. Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing. J Hepatol 2002; 36(1): 93-8. [CrossRef] [PubMed]
Weiss JS, Gautam A, Lauff JJ, Sundberg MW, Jatlow P, Boyer JL, et al. The clinical importance of a protein-bound fraction of serum bilirubin in patients with hyperbilirubinemia. N Engl J Med 1983; 309(3): 147–50. [CrossRef] [PubMed]
Wilkinson IB, Raine T, Wiles K, Goodhart A, Hall C, O'Neill H. Cirrhosis. In: Oxford handbook 10th edition, Oxford university press, 2017: p.276.
World Health Organization. Global status report on alcohol and health 2014: 1–100.
Wu SL, Zheng YX, Tian ZW, Chen MS, Tan HZ. Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy. World J Clin Cases 2018; 6(15): 995–1006. [CrossRef] [PubMed]
Xiol X, Gines P, Castells L, Twose J, Ribalta A, Fientes-Arderiu X, et al. Clinically relevant differences in the model for end-stage liver disease and model for end-stage liver disease-sodium scores determined at three university-based laboratories of the same area. Liver Transpl 2009; 15(3): 300–5. [CrossRef] [PubMed]
Yoo HY, Edwin D, Thuluvath PJ. Relationship of the model for end-stage liver disease (MELD) scale to hepatic encephalopathy, as defined by electroencephalography and neuropsychometric testing, and ascites. Am J Gastroenterol 2003; 98(6): 1395-9. [CrossRef] [PubMed]
Yoon Y-H, Chen CM. Surveillance report #105 - Liver cirrhosis mortality in the United States: national, state, and regional trends, 2000–2013. National Institute on Alcohol Abuse and Alcoholism 2016.
