BACKGROUNDSerum sodium predicts prognosis in chronic severe hepatitis B and may improve the prognostic accuracy of the model for end-stage liver disease (MELD) score, but the available information is limited. The present study was undertaken to study the clinical use of the serum sodium incorporated MELD (MELD-Na) and assess its validity by the concordance (c)-statistics in predicting the prognosis of the patient with chronic severe hepatitis B.

METHODSA total of 426 adult patients with a diagnosis of chronic severe hepatitis B between January 1, 2007, and December 31, 2007 at a single center were studied. The scores of serum sodium, MELD, MELD-Na, and DeltaMELD-Na (DeltaMELD-Na = MELD-Na at 14 days after medical treatment -MELD-Na score on admission) of the patients with chronic severe hepatitis B were calculated. The 3-month mortality in the patients was measured, and the validity of the models was determined by means of the concordance (c) statistics.

RESULTSThe average MELD, MELD-Na scores of survival group were 25.70 +/- 5.08 and 26.60 +/- 6.90, and those of dead group were 35.60 +/- 6.78 and 42.80 +/- 9.57 on admission. There was a significant difference in MELD and MELD-Na between the survival and dead groups (P < 0.01). The average DeltaMELD-Na score of the survival group was -0.97 +/- 3.51, and that of the dead group was 3.45 +/- 2.38 at 2 weeks after the treatment. There was a significant difference in DeltaMELD-Na between the survival and dead groups (P < 0.01). The areas under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 months were 0.742, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group < 25, 25-30, 31-34, 35-40 and > 40 were 2.0%, 5.4%, 35.4%, 53.8 % and 86.9%, respectively. There was a significant difference in the 3-month mortality between the five groups (P < 0.05). The 3-month mortality of the DeltaMELD-Na > 0 group was 65.9%, and that of the DeltaMELD-Na = 0 group was 15.8%; there was a significant difference in the 3-month mortality between the two groups (P < 0.05).

CONCLUSIONSMELD-Na score is a valid model to predict the 3-month mortality in patients with chronic severe hepatitis B. DeltaMELD-Na is a clinically useful parameter for predicting the therapeutic effect of chronic severe hepatitis B.

Adult ; Female ; Hepatitis B, Chronic ; mortality ; Humans ; Liver Cirrhosis ; mortality ; Liver Failure ; mortality ; Male ; Prognosis ; ROC Curve ; Severity of Illness Index ; Sodium ; blood

PURPOSE: Hepatic resection has been considered as the standard treatment method for hepatocellular carcinoma, but the majority of patients have underlying liver cirrhosis that limits the extent of hepatic resection. However, the saftey and long-term results of major hepatic resection for the HCC patient with compensated cirrhosis has not yet been fully evaluated. So, we conducted this study to evaluate the perioperative outcomes and long-term survival following major hepatic resection for hepatocelluar carcinoma (HCC) in the patients with compensated cirrhosis. METHODS: We carried out retrospective analysis on the clinicopathological data of 132 HCC patients with histologically proven liver cirrhosis who underwent hepatic resection for HCC from Sep 1987 to Aug 2003. Among them, 49 HCC patients received major hepatic resection (group A). The perioperative outcomes and long-term survival of group A were compared with those of 83 patients who underwent minor hepatic resection (group B). RESULTS: Group A had significantly better liver function, a wider resection margin, a larger sized tumor, more frequent multiple lesions, and more total and minor complications than group B. However, the two groups showed similar results for the hospital stay, the perioperative blood transfusion and the major complication rate. The only prognostic factor for determining the occurrence of major complication was the transfusion. Both groups did not show statistical differences with regards to 5 year overall and disease free survival rate (67.8% vs 61%, 45.7% vs 35.5%, respectively). CONCLUSION: Major hepatic resection for the hepatocellular carcinoma patient with compensated liver cirrhosis is an effective and safe treatment option with acceptable mortality and major complications rates.
Blood Transfusion ; Carcinoma, Hepatocellular* ; Disease-Free Survival ; Fibrosis ; Hepatectomy* ; Humans ; Length of Stay ; Liver Cirrhosis* ; Liver* ; Mortality ; Retrospective Studies ; Survival Rate

A study carried out to evaluate the bleeding control and prophylactic effect of rebleeding using emergency endoseopic sclerotherapy in patients with hleeding gastric varices. 42 patients with gastric variceal bleeding were admitted to the Yeungnam University Hospital from May, 1983 to August, 1992. Patients were randomly classified into control group, 20 patients treated with conservative management, and sclerotherapy group, 22 patients treated with emergency endoscopic sclerotherapy. The two group were analysed with age, sex, etiology of liver cirrhosis, nature of bleeding episode, hematocrit on admitting day, amount of sclercsants used, rebleeding episodes, complications, and mortality. There were no significant differences in the severity of underlying liver disease and hematocrit on admission between two groups. Blood transfusion were performed in 19 cases of control group and 21 cases in sclerotherapy group(p>0.05). The amounts of transfusion were 7. 7units in control group and 6.1 units in sclerotherapy group(p<0,05). Rebleeding were developed in 65% and 18% of the patiehts with control and sclerotherapy group, respectively(p<0.05). Chest pain and mild fever were observed after endoscopic sclerotherapy. These results suggest that the endoscopic sclerotherapy is effective method in hemostasis of bleeding gastric varices and short-term prevention of rebleeding, but mortality rate was not decreased compared to control group. Development of more effective methods to treat gastric variceal bleeding is required.
Blood Transfusion ; Chest Pain ; Emergencies ; Esophageal and Gastric Varices* ; Fever ; Hematocrit ; Hemorrhage* ; Hemostasis ; Humans ; Liver Cirrhosis ; Liver Diseases ; Mortality ; Sclerotherapy*

BACKGROUND: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. METHODS: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. RESULTS: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. CONCLUSIONS: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism.
Blood Platelets ; Embolization, Therapeutic ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypersplenism* ; Liver ; Liver Cirrhosis ; Mortality ; Pancytopenia ; Prothrombin ; Retrospective Studies ; Splenectomy ; Thrombocytopenia

BACKGROUND/AIMS: Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB. MATERIALS AND METHODS: Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated. RESULTS: NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses. CONCLUSIONS: NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.
Blood Transfusion ; Christianity ; Hemodynamics ; Hemorrhage* ; Hemostasis, Endoscopic ; Hospital Mortality ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Medical Records ; Mortality ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Rupture

BACKGROUND/AIMS: Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB. MATERIALS AND METHODS: Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated. RESULTS: NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses. CONCLUSIONS: NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.
Blood Transfusion ; Christianity ; Hemodynamics ; Hemorrhage* ; Hemostasis, Endoscopic ; Hospital Mortality ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Medical Records ; Mortality ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Rupture

No abstract available.
Bacterial Proteins/blood ; Endopeptidases/blood ; Humans ; Liver Cirrhosis, Biliary/*diagnosis/drug therapy/mortality ; Liver Function Tests ; Prognosis ; Severity of Illness Index ; Survival Rate ; Ursodeoxycholic Acid/therapeutic use

A clinical program in liver transplantation was stared at CMC in June, 1993 and since then, 24 orthotopic liver transplantations were performed (22 adult and 2 children) until July, 1998. The first 11 adult liver transplants (period I) performed from June, 1993 through June, 1997 were compared with the last 11 (period II) performed between July, 1997 and July, 1998. An analysis was made of donor and recipient characteristics, analysis of high risk group, survival data and cause of mortality, prognostic factors of donor and recipient. Mean donor age increased from 32.7 years to 37.2 years and most common cause of brain death were traffic accident and cerebrovascular accident. The highest frequency among recipient was between ages 40 and 59 and the male was predominant (21:1). The major indications for liver transplantation were liver cirrhosis due to hepatitis B or hepatitis C. High risk patients by our criteria comprised 36% of patients in period I compared with 27 % in period II. The survival rate was 45.5% in period I and a substantial improvement was observed in period II with the graft and patient survival rate of 90.9%, 100% respectively. This improved survival rate was correlated with less clinical stage, fewer high risk patient, decreased blood transfusion during operation, early recovery of respiratory and renal function in postoperative course. In conclusion, improved survival rate in period II was contributed by advanced perioperative care and more selected recipient candidate even broadening of donor organ criteria followed by early recovery of organ function.
Accidents, Traffic ; Adult ; Blood Transfusion ; Brain Death ; Hepatitis B ; Hepatitis C ; Humans ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Mortality ; Perioperative Care ; Stroke ; Survival Rate ; Tissue Donors ; Transplants

BACKGROUND/AIMS: The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The MELD score is a reliable measurement of mortality risk and is suitable for a disease severity index in patients with end-stage liver disease. We examined the validity of the MELD as a disease severity index for patients with end-stage liver disease. METHODS: We investigated the 379 patients with liver cirrhosis hospitalized between January 1995 and May 2001. We retrospectively reviewed the hospital records to verify the diagnosis of cirrhosis and to collect exact patient information about their demographic data, portal hypertensive complications and laboratory data. The ability to classify patients with liver cirrhosis according to their risk of death was examined using the concordance c-statistic. RESULTS: The MELD score performed well in predicting death within 3 months with a c-statistic of 0.73 with etiology and 0.71 without etiology. The significant clinical, laboratory variables on 3 month survival in patients with liver cirrhosis are serum bilirubin, ascites and hepatic encephalopathy. The addition of portal hypertensive complications to the MELD score did not improve the accuracy of the MELD score. CONCLUSIONS: The MELD score is a useful disease severity index for the patients with end-stage liver disease and provides reliable measurement of short term survival over a wide range of liver disease severity and diverse etiology.
Adult ; Bilirubin/blood ; Creatinine/blood ; Female ; Humans ; International Normalized Ratio ; Liver Cirrhosis/blood/*mortality ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index ; Survival Rate

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.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate