In the early 1950s, Child and Turcotte attempted to identify high risk patients by laboratory factors (serum bilirubin and albumin) and clinical factors (ascites, encephalopathy, nutritional status) prior to surgery for portal hypertension. 4, 5 Although most research has been done prior to the MELD-Na score, we review the literature on historical and novel factors that might be extended to identify the group of ‘low MELD-Na’ patients who suffer liver related complications and may benefit from earlier liver transplant, the use of more marginal liver grafts, or more intensive nontransplant treatments.Ī Brief History of Risk Scoring for Liver Disease SeverityĪdvancements in risk prediction for liver disease severity have been largely driven by identifying populations at high risk for complications after procedures. 3 Furthermore, the vast majority of patients listed for transplant must deal with this issue, with a 2004 study finding 92% of waitlisted patients had a MELD score of 18 or less and a more recent 2014 analysis noting 73.4% of patients were initially listed with a MELD less than 16. 1, 2 However, though patients with lower MELD-Na scores are de-prioritized with regards to liver transplant, they may still have a significant burden of liver related mortality. The Model for End Stage Liver Disease – Sodium (MELD-Na) score has been repeatedly shown to accurately predict three month mortality at high scores and is currently used to prioritize recipients for liver transplant allocation. Nowhere has this been more apparent than in the field of end stage liver disease and liver transplantation where sparse organ availability has required careful allocation. With increasingly modern approaches, patients can be prioritized for life saving procedures or maneuvered away from potentially dangerous ones. Prediction and prognosis has been a quintessential aspect of the art of medicine since its inception.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |