Reuters Health Information (2008-06-02): Liver disease score predicts outcome of variceal hemorrhage
Liver disease score predicts outcome of variceal hemorrhage
Last Updated: 2008-06-02 15:16:49 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients with cirrhosis and acute variceal hemorrhage, the MELD (Model for End-stage Liver Disease) score and the need for packed red blood cells (PRBCs) are indicative of early re-bleeding and death, researchers report in the June issue of Gut.
Dr. Patrick S. Kamath and colleagues at the Mayo Clinic, Rochester, Minnesota note that there is no well-established model for accurate prediction of survival after variceal bleeding in patients with cirrhosis.
However, they point out, the MELD score for classifying liver transplant candidates was originally developed from a cohort of patients with cirrhosis undergoing intrahepatic portosystemic shunting.
The researchers investigated the prognostic utility of the MELD score in 256 cirrhotic patients with acute variceal hemorrhage who had taken part in a subsequently abandoned randomized clinical trial of lanreotide, an agent that proved to have no influence on the condition.
Thirty-five patients (14%) died within 6 weeks of hemorrhage and 14 (40%) of these deaths took place within 5 days.
Univariate analysis showed that only the MELD score and the number of units of PRBCs needed during the first 24 hours were predictive of death. For every 1 point increase in the MELD score there was an 8% increase in the risk of death at 5 days and an 11% increase at 6 weeks.
In total, 37 patients (15%) experienced re-bleeding within 5 days. For every 1 point increase in the MELD score, there was a 5% increase in the risk of re-bleeding within 5 days. In addition, patients with a MELD score of 18 or more were at significantly greater risk than those with lower scores.
Dr. Kamath told Reuters Health that, because patients with a MELD score of more than 18 who require more than 4 units of red-cell transfusion are at greater risk for 6-week mortality, "these patients should preferably be treated at or referred promptly to centers that carry out liver transplantation."
In addition, because patients with a MELD score of greater than 18 have a higher risk of re-bleeding within days, he concluded, such patients with "active esophageal variceal bleeding should be hospitalized for at least 5 days."