A Study on the Clinico-etiological Profile of Cirrhosis of the Liver and Prognostic Value of the MELD Score on Short-term Survival
Gouri S Mahapatra, Koustav A Shah, Atanu Chandra, Mrinal K Roy
Autoimmune hepatitis, Chronic liver disease, Cirrhosis of the liver, MELD score ,Wilson's disease
Citation Information :
Mahapatra GS, Shah KA, Chandra A, Roy MK. A Study on the Clinico-etiological Profile of Cirrhosis of the Liver and Prognostic Value of the MELD Score on Short-term Survival. Bengal Physician Journal 2020; 7 (3):57-59.
Introduction: Although there are a large number of patients with chronic liver disease (CLD) in India, the clinico-etiological profile of cirrhosis of the liver and exact prognostic value of the model for end-stage liver disease (MELD) score on short-term survival is scarce, and it needs further evaluation.
Aims: To study the etiology of cirrhosis of the liver; observe the clinical manifestations at the time of presentation and the subsequent development of complications in patients having cirrhosis; and calculate the MELD score and assess its usefulness as a prognostic marker in short-term survival of patients with cirrhosis.
Methodology: A prospective longitudinal study was performed on 50 patients who presented to our institution with CLD. Patients were subjected to clinical examination and laboratory investigations. The severity of the liver disease was assessed by the MELD score.
Results: Alcohol was the most common etiological factor for cirrhosis in 60% patients followed by cryptogenic in 22%, autoimmune hepatitis in 6%, Wilson's disease in 6%, alcohol with hepatitis B in 4%, and hepatitis C in 2% patients. Patients with a MELD score of 40 or more have 0% 3-month survival rate. The 3-month survival rate in patients having a MELD score of 30 to 39 is 50%, followed by 75% in patients having a MELD score of 20 to 29. Patients with a MELD score ≤9 have 100% 3-month survival rate.
Conclusion: Alcohol was the most common etiological factor for cirrhosis in our study. Three-month survival rates were inversely related to the MELD score.
Inaba K, Barmparas G, Resnick S, et al. The Model for End-Stage Liver Disease score: an independent prognostic factor of mortality in injured cirrhotic patients. Arch Surg 2011;146(9):1074–1078. DOI: 10.1001/archsurg.2011.109. PMID: 21576598.
Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med 2014;12(1):145. DOI: 10.1186/s12916-014-0145-y.
Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol 2019;70(1):151–171. DOI: 10.1016/j.jhep.2018.09.014. PMID: 30266282.
Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic liver disease: pathogenesis and current management. Alcohol Res 2017;38(2):147–161. PMID: 28988570. PMCID: PMC5513682.
Wiegand J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Dtsch Arztebl Int 2013;110(6):85–91. DOI: 10.3238/arztebl.2013.0085. PMID: 23451000. PMCID: PMC3583179.
Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45(4):529–538. DOI: 10.1016/j.jhep.2006.05.013.
Carr RM, Oranu A, Khungar V. Nonalcoholic fatty liver disease: pathophysiology and management. Gastroenterol Clin North Am 2016;45(4):639–652. DOI: 10.1016/j.gtc.2016.07.003. PMID: 27837778. PMCID: PMC5127277.
World Life Expectancy. India: liver disease. World health rankings. World Life Expectancy; 2018. Available from: https://www.worldlifeexpectancy.com/india-liver-disease [Accessed on November 9].
Bhattacharyya M, Barman NN, Goswami B. Survey of alcohol-related cirrhosis at a tertiary care center in North East India. Indian J Gastroenterol 2016;35(3):167–172. DOI: 10.1007/s12664-016-0651-2.
Mukherjee PS, Vishnubhatla S, Amarapurkar DN, et al. Etiology and mode of presentation of chronic liver diseases in India: a multi centric study. PLoS One 2017;(10):12. DOI: 10.1371/journal.pone.0187033.
Sarin SK, Chari S, Sundaram KR, et al. Young v adult cirrhotics: a prospective, comparative analysis of the clinical profile, natural course and survival. Gut 1988;29(1):101–107. DOI: 10.1136/gut.29.1.101.
Thakur S, Raina S, Thakur S, et al. Prevalence of metabolic syndrome among newly diagnosed hypertensive patients in the hills of Himachal Pradesh, India. Indian J Endocr Metab 2013;17(4):723–726. DOI: 10.4103/2230-8210.113768.
Dilawari JB, Bambery P, Chawla Y, et al. Hepatic outflow obstruction (Budd-Chiari syndrome). Experience with 177 patients and a review of the literature. Medicine (Baltimore) 1994;73(1):21–36. DOI: 10.1097/00005792-199401000-00003. PMID: 8309360.
Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33(2):464–470. DOI: 10.1053/jhep.2001.22172.
Forman LM, Lucey MR. Predicting the prognosis of chronic liver disease: an evolution from Child to MELD. Hepatology 2001;33(2):473–475. DOI: 10.1053/jhep.2001.22481.
Giannini E, Botta F, Testa E, et al. The 1-year and 3-month prognostic utility of the AST/ALT ratio and model for end-stage liver disease score in patients with viral liver cirrhosis. Am J Gastroenterol 2002;97(11):2855–2860. DOI: 10.1111/j.1572-0241.2002.07053.x.
Heuman DM, Abou-Assi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology 2004;40(4):802–810. DOI: 10.1002/hep.20405.