背景:终末期肝病(MELD)模型,终末期肝病模型-钠(MELDNa),Child-Turcotte-Pugh(CTP)评分是肝硬化患者死亡率的独立预测因子。患有晚期疾病的肝硬化患者中约有43%是脆弱的,并且可能对疾病的预后和生存产生不利影响,包括从移植清单中除名和增加移植后并发症的风险。因此,我们的目的是确定MELD的相关性,MELD-Na,丙型肝炎病毒(HCV)相关性肝硬化患者的CTP评分与虚弱。
方法:这项横断面研究是在肝胃肠病科进行的,信德省泌尿外科和移植研究所,2022年1月1日至2022年6月30日。研究包括所有年龄在18至70岁之间,具有HCV血清学证据和超声腹部肝硬化特征的患者。患有估计虚弱的疾病的患者被排除在研究之外。使用以千克为单位的握力计算肝脏虚弱指数(LFI),定时椅子的立场,平衡测试。记录每位患者的CTP和MELD-Na评分。所有数据均使用SPSS22.0版(IBMCorp.,Armonk,NY).MELD的相关性,MELD-Na,使用Pearson相关系数对具有LFI的CTP进行分析,p值<0.05被认为具有统计学意义。
结果:本研究共纳入274例患者。在他们当中,185(67.5%)为男性。平均CTP评分为8.1+2.1,MELD评分为13.6+7.1,MELD-Na评分为15+6.6,LFI为4.1+0.83。发现LFI与MELD弱相关(r=0.278)(p<0.001),MELD-Na评分(r=0.41)(p<0.001),CTP评分(r=0.325)(p<0.001)。
结论:LFI,CTP,MELD,与HCV相关的慢性肝病的MELD-Na评分。因此,随着MELD的脆弱,MELD-Na,在考虑患者进行肝移植之前,必须对CTP进行评估。
BACKGROUND: The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients. Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis.
METHODS: This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1st January 2022 to 30th June 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant.
RESULTS: A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001).
CONCLUSIONS: Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.