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Background: Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear. Methods: The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed. Results: Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001). Discussion: High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation. [ABSTRACT FROM AUTHOR]

Background & Aims: Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy. MHE has been associated with impairment of quality of life and job performance, and is a major cause of premature retiring in cirrhotic patients. However, MHE is usually overlooked by most physicians, due to its asymptomatic nature. We aim to present our experience with the EncephalApp Stroop Test for diagnosing MHE in cirrhotic patients. We also want to establish if Stroop test performance correlates with age, educational level, liver disease severity (as assessed by the MELD and Child-Pugh scores), duration of disease, previous episodes of overt hepatic encephalopathy, and other relevant clinical or laboratory parameters. Methods: A cross-sectional observational single-center study, in which 100 adult patients diagnosed with liver cirrhosis were evaluated for the presence of MHE by using the EncephalApp Stroop Test. In parallel, 45 healthy adult controls without liver cirrhosis were recruited and tested under the same conditions as the patients. Results: There were no age-related differences between the two groups (p=0.6). Stroop test performance of the controls (143.1 ± 20.8 seconds) was significantly better than that of the patients (171.9 ± 33.3 seconds) (p<0.0001). Stroop test results correlated with the MELD (R=0.28, p=0.005) and Child-Pugh scores (R=0.2, p=0.04). There was a positive correlation between Stroop test results and age in patients (R=0.45, p<0.0001) and controls (R=0.75, p<0.0001). Stroop test performance was not influenced by the duration of liver disease (p=0.4) or prior episodes of overt hepatic encephalopathy (p=0.25). Gender and level of education did not have an impact on Stroop test results. Alcoholic liver disease, diabetes mellitus, hyperglycemia, anemia and hyponatremia were associated with poorer performances. Conclusions: EncephalApp Stroop Test proved to be a quick and simple method for diagnosing minimal hepatic encephalopathy in the hospital setting. Test performance was influenced primarily by age, but also by liver disease severity, anemia, hyponatremia and hyperglycemia. [ABSTRACT FROM AUTHOR]

Aim: Extracorporeal membrane oxygenation (ECMO) is resource-intensive, is associated with significant morbidity and mortality, and requires careful patient selection. This study examined whether the model for end-stage liver disease (MELD) score is a suitable predictor of in-hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively assessed patients with COVID-19 on ECMO at our institution from March 2020 to May 2021. MELD scoring was performed using laboratory values recorded prior to ECMO initiation. A multiple logistic regression model was established. Results: A total of 66 patients with COVID-19 on ECMO were included (median age of 58.5 years; 83.3% male). The in-hospital mortality was 74.2%. In relation to mortality, patients with MELD Na scores >13.8 showed 6.5-fold higher odds, patients aged >53.5 years showed 18.4-fold higher odds, and male patients showed 15.9-fold higher odds. The predictive power of a model combining the MELD Na with age and sex was significant (AUC = 0.883, p < 0.001). The findings in the COVID-19 patients were not generalizable to a group of non-COVID-19 patients on ECMO. Conclusions: A model combining the MELD Na, age, and sex has high predictive power for in-hospital mortality in patients with COVID-19 on ECMO, and it may be clinically useful for guiding patient selection in critically ill COVID-19 patients both now and in the future, should the virus widely re-emerge. [ABSTRACT FROM AUTHOR]

Liver transplantation (LT) in patients with alcohol‐associated hepatitis (AH) has rapidly increased following the coronavirus disease 2019 pandemic and the implementation of the Acuity Circle policy, raising questions of equity and utility. Waitlist mortality among high (≥37) Model for End‐Stage Liver Disease LT candidates with AH and post‐transplant survival were assessed with a semiparametric survival regression and a generalized linear mixed‐effect model with LT centre‐ and listing date‐level random intercepts. These models demonstrate a lower mortality for the candidates listed with AH (adjusted sub‐hazard ratio.58_.72_.90 and odds ratio.44_.66_.99) when compared to other diagnoses (autoimmune hepatitis, metabolic dysfunction‐associated fatty liver disease and primary biliary cholangitis). Post‐LT survival was comparable. This study highlights the limitations of current tools in characterizing the risk of mortality, and thus need for the modifications in prioritizing LT candidates with AH. Policy revision may be needed to ensure equivalent access to LT regardless of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Alcoholic Liver Disease (ALD) poses a significant global health threat, contributing to millions of deaths each year. Despite the well-established link between chronic alcohol consumption and liver damage, treatment options remain limited, emphasizing the need for innovative approaches. Methods: An open-label, randomized controlled trial was conducted in India, involving 68 adult ALD patients over a 12-week period. The patients were randomized into two groups: one receiving standard therapy and the other receiving standard therapy along with BoozLiv™ syrup. Liver function tests, Model for End-Stage Liver Disease (MELD) scores, and safety parameters were assessed at various intervals. Results: The study demonstrated that BoozLiv™ syrup, as an add-on therapy, significantly reduced total bilirubin, direct bilirubin, SGOT, SGPT, ALP, and GGT levels compared to standard therapy alone (p ​

Purpose: Several risk calculators have been developed and deployed to help surgeons estimate the mortality risk that comes with performing hernia repair surgery on patient with severe liver disease. This study seeks to evaluate the accuracy of these risk calculators on patients with cirrhosis and identify the most suitable population of patient to use these calculators on. Methods: The American College of Surgeons National Surgery Quality Improvement Program (NSQIP) 2013–2021 datasets were queried for patients who underwent hernia repair surgery. Mayo Clinic's "Post-operative Mortality Risk in Patients with Cirrhosis" risk calculator, Model for End-Stage Liver Disease (MELD) calculator, NSQIP's Surgical Risk Calculator, and a surgical 5-item modified frailty index were assessed to determine whether they accurately predict mortality following abdominal hernia repair. Results: In total, 1368 patients met inclusion criteria. Receiver operating characteristic (ROC) curve analysis of the 4 mortality risk calculators resulted in the following: NSQIP Surgical Risk Calculator = 0.803 (p < 0.001); "Post-operative Mortality Risk in Patients with Cirrhosis" with an etiology of "Alcoholic or Cholestatic" yielded an AUC = 0.722 (p < 0.001); MELD score yielded an AUC = 0.709 (p < 0.001); and the modified 5-item frailty index yielded an AUC = 0.583 (p = 0.04). Conclusion: The NSQIP Surgical Risk Calculator more accurately predicts 30-day mortality in patients with ascites undergoing hernia repair. However, if the patient is missing one of the 21 input variables required by this calculator, Mayo Clinic's 30-day mortality calculator should be consulted before the more widely used MELD score. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis presents significant challenges in the pediatric population due to a complex interplay of etiological factors, clinical manifestations, and limited therapeutic options. The leading contributors to cirrhosis among pediatric patients are chronic cholestasis, metabolic disorders present from birth, and long-term hepatitis. Materials and method: Our narrative review aimed to synthesize literature data on the etiology, clinical picture, diagnostic techniques, optimal management of complications, and timely transplantation. Results: The epidemiology of liver cirrhosis in pediatric patients is evolving. The introduction of a universal vaccination and effective long-term viral suppression in viral hepatitis have significantly decreased complications rates. Liver transplantation programs worldwide have also improved the management of cirrhosis complications. Conclusions: Early diagnosis, comprehensive management strategies, and advancements in treatment modalities are critical for improving outcomes. Understanding these differences is crucial in providing age-appropriate care and support for those affected by cirrhosis. [ABSTRACT FROM AUTHOR]

Introduction: Frailty and sarcopenia are associated with an increased risk of hospitalization and mortality in patients with end‐stage liver disease. The ability to identify frail patients at risk of adverse outcomes could help optimize liver transplant (LT) evaluations and pre‐transplant care. This study compared sarcopenia, via L3‐psoas muscle index (L3‐PMI), to frailty, via liver frailty index (LFI) and analyzed associated outcomes after liver transplantation (LT). Methods: A retrospective review of consecutive LT‐recipients with cross‐sectional abdominal/pelvic imaging were reviewed over 5 years at a single transplant center. Results: Four hundred and twenty‐six patients underwent transplant during this study interval; 31% of patients were sarcopenic. Two hundred eight patients underwent LFI evaluation: 25% were frail, 59% were prefrail, and 16% were robust. Sarcopenic patients had higher LFI scores indicating greater frailty (p = 0.02). Both sarcopenia and LFI‐frailty were associated with significantly higher MELD‐Na scores. Length of post‐LT hospital stay was increased in sarcopenic (mean 14 vs. nonsarcopenic 11 days, p = 0.02) and LFI‐frail patients (mean 13 vs. 10 prefrail, 8 robust, p = 0.04). As a categorical variable, neither LFI‐frailty nor sarcopenia were significantly associated with reduced survival at 1‐year (robust 100%, prefrail 93.5%, frail 91.1%, p = 0.31) (nonsarcopenic 94.4%, sarcopenic 91.4%, p = 0.30). However, LFI score was significantly associated with mortality at 1‐year (OR 2.133, p = 0.047). Conclusions: Radiographic sarcopenia is a suitable proxy for in‐person frailty assessment as both L3‐PMI and LFI capture frail patients' pre‐LT. However, physical assessment with frailty better predicts 1‐year mortality post‐LT than the measurement of muscle mass. [ABSTRACT FROM AUTHOR]

Individuals with cirrhosis experience higher morbidity and mortality rates than the general population, irrespective of the type or scope of surgery. This increased risk is attributed to adverse effects of liver disease, encompassing coagulation dysfunction, altered metabolism of anesthesia and sedatives, immunologic dysfunction, hemorrhage related to varices, malnutrition and frailty, impaired wound healing, as well as diminished portal blood flow, overall hepatic circulation, and hepatic oxygen supply during surgical procedures. Therefore, a frequent clinical dilemma is whether surgical interventions should be pursued in patients with cirrhosis. Several risk scores are widely used to aid in the decision-making process, each with specific advantages and limitations. This review aims to discuss the preoperative risk factors in patients with cirrhosis, describe and compare surgical risk assessment models used in everyday practice, provide insights into the surgical risk according to the type of surgery and present recommendations for optimizing those with cirrhosis for surgical procedures. As the primary focus is on currently available risk models, the review describes the predictive value of each model, highlighting its specific advantages and limitations. Furthermore, for models that do not account for the type of surgical procedure to be performed, the review suggests incorporating both patient-related and surgery-related risks into the decision-making process. Finally, we provide an algorithm for the preoperative assessment of patients with cirrhosis before elective surgery as well as guidance perioperative management. [ABSTRACT FROM AUTHOR]

Objectives: Liver transplantation (LT) is the main therapy for patients with cirrhosis or fulminant liver failure. However, there is a disproportion between the demand and availability of organs, such that the waitlist mortality ranged from 20 to 38% when the only allocation criterion was the time of inclusion on the waitlist. Brazil then adopted the Model for End-stage Liver Disease (MELD) score, aiming to prioritize patients with a higher risk of death for LT. Therefore, this study aimed to determine factors associated with waitlist time for LT. Methods: Retrospective cohort study of adult patients listed for LT from October 2012 to December 2019 in a single state in Brazil. Results: !e study analyzes 1,262 patients (869 males, 68.91%; median age, 53.33 ± 11.48 years; median waitlist time, 103.88 ± 162.05 days; median MELD Sodium [MELD-Na] score of 22.41 ± 6.09). Alcoholic liver cirrhosis (n = 369; 29.24%) and chronic viral hepatitis (n = 295; 23.38%) were the most prevalent reasons for LT. Blood groups O (n = 534; 42.31%) and A (n = 474; 37.56%) prevailed among the recipients. !e state capital and its metropolitan region accounted for 91.20% (n = 1,151) of all liver transplants performed. Most donors were deceased (n = 1,258; 99.68%). Patients with MELD-Na scores > 21 (p < 0.001), non-O blood group (p = 0.002), age < 53 years (p = 0.003), and those listed " 2017 spent # 30 days on the waitlist (p < 0.001). Conclusion: A waitlist period of # 30 days was associated with higher MELD-Na scores, younger ages, non-O blood groups, and LT listings before 2017.

We find minimal literature and lack of consensus among burn practitioners over how to resuscitate thermally injured patients with pre-existing liver disease. Our objective was to assess burn severity in patients with a previous history of liver disease. We attempted to stratify resuscitation therapy utilised, using it as an indicator of burn shock severity. We hypothesized that as severity of liver disease increased, more fluid therapy is needed. We retrospectively studied adult patients with a total body surface area (TBSA) of burn greater than or equal to 20% (n = 314). We determined the severity of liver disease by calculating admission Model for End-Stage Liver Disease (MELD) scores and measured resuscitation adequacy via urine output within the first 24 h. We performed stepwise, multivariable linear regression with backward selection to test our hypothesis with α = 0.05 defined a priori. After controlling for important confounders including age, TBSA, baseline serum albumin, total crystalloids, colloids, blood products, diuretics, and steroids given in first 24 h, we found a statistically significant reduction in urine output as MELD score increased (p < 0.000). In our study, severity of liver disease correlated with declining urine output during first 24-hour resuscitation more so than burn size or burn depth. While resuscitation is standardized for all patients, lack of urine output with increased liver disease suggests a new strategy is of benefit. This may involve investigation of alternate markers of adequacy of resuscitation, or developing modified resuscitation protocols for use in patients with liver disease. More investigation is necessary into how resuscitation protocols may best be modified. • Aggressive fluid resuscitation using formulas like modified Brooke and Parkland, monitoring urine output as an indicator. • Cirrhotic burn patients face more complications, longer ICU stays, and higher mortality rates than non-cirrhotic patients. • The Model for End-Stage Liver Disease (MELD) score guides resuscitation outcomes, indicating liver disease severity. • Albumin-based colloid resuscitation for high MELD score patients can manage volume status and prevent hepatorenal syndrome. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to evaluate the role of regional social vulnerability in geographic disparity for patients listed for liver transplantation with non–hepatocellular carcinoma (HCC) model for end-stage liver disease (MELD) exceptions. Summary and Background: Prior work has demonstrated regional variability in the appropriateness of MELD exceptions for diagnoses other than HCC. Methods: Adults listed at a single center for first-time liver-only transplantation without HCC after June 18, 2013 in the Scientific Registry of Transplant Recipients database as of March 2021 were examined. Candidates were mapped to hospital referral regions (HRRs). Adjusted likelihood of mortality and liver transplantation were modeled. Advantaged HRRs were defined as those where exception patients were more likely to be transplanted, yet no more likely to die in adjusted analysis. The Centers for Disease Control’s Social Vulnerability Index (SVI) was used as the measure for community health. Higher SVIs indicate poorer community health. Results: There were 49,494 candidates in the cohort, of whom 4337 (8.8%) had MELD exceptions. Among continental US HRRs, 27.3% (n = 78) were identified as advantaged. The mean SVI of advantaged HRRs was 0.42 versus 0.53 in nonadvantaged HRRs (P = 0.002), indicating better community health in these areas. Only 25.3% of advantaged HRRs were in spatial clusters of high SVI versus 40.7% of nonadvantaged HRRs, whereas 44.6% of advantaged HRRs were in spatial clusters of low SVI versus 38.0% of nonadvantaged HRRs (P = 0.037). Conclusions: An advantage for non-HCC MELD exception patients is associated with lower social vulnerability on a population level. These findings suggest assigning similar waitlist priority to all non-HCC exception candidates without considering geographic differences in social determinants of health may actually exacerbate rather than ameliorate disparity. [ABSTRACT FROM AUTHOR]

(1) Background: The use of extracorporeal membrane oxygenation (ECMO) in low cardiac output states after cardiac surgery may aid in patient recovery. However, in some patients, the clinical state may worsen, resulting in multiple organ failure and high mortality rates. In these circumstances, calculating a model of end-stage liver disease (MELD) score was shown to determine organ dysfunction and predicting mortality. (2) Methods: We evaluated whether serial MELD score determination increases mortality prediction in patients with postcardiotomy ECMO support. (3) Results: Statistically, a cutoff of a 2.5 MELD score increase within 48 h of ECMO initiation revealed an AUC of 0.722. Further, we found a significant association between hospital mortality and 48 h MELD increase (HR: 2.5, 95% CI: 1.33–4.75, p = 0.005) after adjustment for possible confounders. (4) Conclusions: Therefore, serial MELD score determinations on alternate days may be superior to single measurements in this special patient cohort. [ABSTRACT FROM AUTHOR]

Introduction: Alcoholic hepatitis is a major health problem which carries a high mortality despite treatment. Predicting severity of disease is of utmost importance to avoid overzealous and unnecessary treatment with steroids in each and every case. Maddrey’s discriminant function (DF) may not always be reliable in predicting such prognosis. Aim of the Study: To observe the predictive ability of Glasgow alcoholic hepatitis score (GAHS), age, bilirubin, international normalized ratio (INR) and creatinine (ABIC) score, model for end stage liver disease (MELD) score, and Lille’s score in determining the prognosis in severe alcoholic hepatitis. Materials and Methods: Patients of severe alcoholic hepatitis were enrolled in this study as per inclusion and exclusion criteria and a DF score of >32. Once the decision to initiate corticosteroids was made, DF scores, MELD scores, GAHS scores, and ABIC scores were calculated on the day on initiation of therapy. On day 7, patients were re‑assessed and Lille score was calculated in addition. Follow‑up was obtained on repeat out‑patient visit or telephonically after every 2 weeks till 90 days or till mortality, whichever occurred first. Statistical Analysis: The scores were compared among the survival and mortality groups to see association between mortality and severity of scores using Chi‑square test of significance. Cut‑offs providing a composite of best sensitivity, specificity, negative predictive value, and positive predictive value were derived on the basis of data of our study. P value of ≤ 0.05 was taken as a cut‑off for significance. Results: Our study comprised 30 patients with severe alcoholic hepatitis. At the end of 90‑day follow‑up, 23 patients survived with 7 (23%) mortalities because of liver failure and sepsis. On day 7, barring the ABIC score (0.713), the areas under curve of all scores were above 0.8 and were hence of comparable efficacy. Lille score performed the best at assessing treatment response but had the limitation of not being applicable at day 1. Conclusion: Severe alcoholic hepatitis carries a bad prognosis. Cut‑offs of DF and MELD need to be raised, whereas they need to be lowered in the case of GAHS, ABIC, and Lille score to improve the predictive value of score. Steroid‑treated patients should be evaluated preferably with Lille score for a better prediction of survival. [ABSTRACT FROM AUTHOR]

IntroductionLiver transplant recipients are at a heightened risk for oropharyngeal dysphagia; identification of those who are at high risk for postoperative dysphagia could reduce hospital costs and length of stay. We sought to identify predictors of dysphagia, in a large cohort of patients who underwent liver transplantation.MethodsElectronic medical records were queried for patients undergoing liver transplantation, who underwent instrumental swallowing evaluations. Demographics, functional outcomes, and interventions were collected. Logistic regression analyses were performed to identify predictors of dysphagia.ResultsSeven hundred and ninety-five patients met inclusionary criteria. Multivariate analyses found ethnic group (p = .0191), MELD Score (p

Background: In individuals with terminal-stage liver disease, spontaneous peritonitis, particularly spontaneous fungal peritonitis, is a serious fatal condition. We assessed different risk variables, microbiological results, and patient outcomes in SFP patients compared to patients with spontaneous bacterial peritonitis. Objective: We aimed to evaluate the frequency and risk factors for the development of SFP in cirrhotic patients with ascites. Patients and methods: We conducted a cross-sectional study on 154 cirrhotic patients with ascites (102 males and 52 females) who were admitted to the Tropical Medicine and Gastroenterology Departments in our Hospital. The samples were sent to the clinical and chemical pathology laboratory at Sohag university hospital. Detailed history, clinical examination, ascitic fluid analysis, laboratory investigations, abdominal ultrasonography, and bacterial and fungal cultures from ascitic fluid were performed. Results: The patients were categorized into 3 groups according to the ascitic fluid analysis and the bacterial and fungal culture. The first group included 69 patients (44.5%) who were diagnosed with SBP. The second group included 15 patients (9.7%) who were diagnosed with SFP. The third group included 71 patients (45.8%) who were diagnosed with liver cirrhosis without ascitic fluid infection. As regard the bacterial and fungal culture of ascitic fluid, Escherichia coli was the most reported bacterial infection (32.7%) followed by Klebsiella pneumonia (22.4%), while Candida ciferrii was the most reported fungal infection (10.2%) followed by Candida albicans (8.2%). Conclusions: SFP is not a rare complication of liver cirrhosis with ascites. It should be considered mainly in patients with high Model of End-stage Liver Disease and Child-Turcotte- Pugh scores.

Background-The high mortality of cirrhosis is a global public health problem. For predicting the outcome of patients with cirrhosis, many prognostic models were proposed.The new Model for End-Stage Liver Disease including serum sodium (MELD-Na) has been proposed as an alternative to the original MELD, to increase the accuracy of the score in predicting short-term mortality. The purpose of this study was to assess the ability of MELD-Na scoring system to predict three-month mortality among cirrhotic patients, and comparing it to the MELD score. Methods-An observational study was carried out, at the Hepato-Gastro-Enterology De­partment of the University Hospital Center of Oran. A retrospective review of the medical records of all patients with cirrhosis, between 1st January 2019 and 31st December 2021, was performed. Among 103 patients, 47 were selected after excluding the patients who were lost to follow-up after three months or with missing data. The information collected included demographic data, clinical characteristics and laboratory values of: bilirubin, creatinine, international normalized ratio (INR) of prothrombin and sodium. The MELD-Na and MELD scores were calculated using online calculators, then the ability of the mo­dels to predict the risk of mortality at three months was assessed, using the area under the receiver operating characteristic curve (AUC). Results - : Eight (17%) patients died at three months. The MELD-Na and MELD both had significantly high area under the curve (AUC): MELD-Na: 0.952, 95% confidence interval [CI]: 0.885–1.00, MELD: 0.931, 95% confidence interval [CI]: 0.834–1.000. The MELD-Na score was slightly better than the MELD, with a sensitivity and a specificity of 87.5% and 87.2%, respectively, for a cut-off value = 21. Conclusion -The MELD-Na score seems to be a good predictor of mortality at three mon­ths among patients with cirrhosis..

Abstract Background Patients with decompensated cirrhosis (DC) are prone to skeletal muscle loss, namely, sarcopenia, before liver transplantation (LT). While sarcopenia is reportedly associated with adverse outcomes after LT, these findings are limited owing to mixed diseases and retrospective data. We investigated the association between sarcopenia and 1‐year overall survival (OS) in patients with DC after LT and established and validated a prediction model for postoperative OS based on sarcopenia. Methods Overall, 222 consecutive patients who underwent LT at our centre were registered between September 2020 and June 2022. Third lumbar spine skeletal muscle mass index was measured using computed tomography. Patients were divided into sarcopenia and non‐sarcopenia groups according to the skeletal muscle mass index, and baseline data and postoperative outcomes were collected, compared and analysed. The primary outcome was the 1‐year OS after LT. We established a dynamic nomogram of the OS predictive model. Results We included 177 DC patients [mean (standard deviation) age, 50.2 ± 9.3 years; 52 women (29.4%)]; 73 (41.2%) had sarcopenia. The mean (standard deviation) body mass index was 22.6 ± 4.5 kg/m2, 28 (15.8%) patients had weight loss ≥5% within 6 months before admission, and the mean (standard deviation) model for end‐stage liver disease (MELD) score was 18.4 ± 7.9. Patients with sarcopenia had a longer duration of intensive care unit stay (4.1 ± 2.2 vs. 3.1 ± 1.1 days, P = 0.008), higher rate of major complications (45.2% vs. 22.1%, P = 0.001) and higher postoperative mortality (15.1% vs. 2.9%, P = 0.003) than those without sarcopenia. The median 1‐year OS after surgery was shorter in patients with sarcopenia than in those without (P 102.9 points calculated using the nomogram) had a significantly reduced survival rate. Conclusions Sarcopenia is associated with adverse outcomes after LT in patients with DC. High‐risk patients should be classified by dynamic nomogram upon admission.

Objective: Liver disease (LD) is considered a risk factor for inferior outcomes in general and cardiac surgery, yet current cardiac surgery risk estimators exclude LD, and literature on the topic remains scant. We sought to evaluate whether the presence of advanced LD is associated with inferior outcomes following cardiac surgery. Methods: This single-center, retrospective, observational study included 285 patients diagnosed with LD who underwent cardiac surgery in 2010 to 2020. The cohort contained 3 groups, Child-Turcotte-Pugh (CTP) class A (n = 219), CTP early-class B (n = 34), and CTP advanced-class B (n = 32). A model for end-stage liver disease score of 12.7 points (determined using a receiver-operating characteristic curve analysis on 30-day mortality) dichotomized class B into early- and advanced-groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of 30-day mortality. Results: Patients in CTP advanced-class B had the longest length of stay (14 days), highest incidence of prolonged ventilation (46.9%), renal failure (21.9%), 30-day mortality (18.8%), and in-hospital mortality (18.8%). Incidence of ≥1 postoperative complication was higher in CTP advanced-class B (59.4%), compared with CTP class A (37.9%) and CTP early-class B (38.2%). Multivariate logistic regression analysis demonstrated that female sex (odds ratio, 3.01; 95% CI, 1.07-8.77; P = .037) and peripheral vascular disease (odds ratio, 4.01; 95% CI, 1.33-12.2; P = .013) were independent predictors of 30-day mortality in patients with advanced LD. Conclusions: Severity of LD influences perioperative outcomes following cardiac surgery. Our data suggest that patients in CTP class A and selected patients in CTP class B (model for end-stage liver disease score

Aim: Extracorporeal membrane oxygenation (ECMO) is resource-intensive, is associated with significant morbidity and mortality, and requires careful patient selection. This study examined whether the model for end-stage liver disease (MELD) score is a suitable predictor of in-hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively assessed patients with COVID-19 on ECMO at our institution from March 2020 to May 2021. MELD scoring was performed using laboratory values recorded prior to ECMO initiation. A multiple logistic regression model was established. Results: A total of 66 patients with COVID-19 on ECMO were included (median age of 58.5 years; 83.3% male). The in-hospital mortality was 74.2%. In relation to mortality, patients with MELD Na scores >13.8 showed 6.5-fold higher odds, patients aged >53.5 years showed 18.4-fold higher odds, and male patients showed 15.9-fold higher odds. The predictive power of a model combining the MELD Na with age and sex was significant (AUC = 0.883, p < 0.001). The findings in the COVID-19 patients were not generalizable to a group of non-COVID-19 patients on ECMO. Conclusions: A model combining the MELD Na, age, and sex has high predictive power for in-hospital mortality in patients with COVID-19 on ECMO, and it may be clinically useful for guiding patient selection in critically ill COVID-19 patients both now and in the future, should the virus widely re-emerge.

In this review article, we discuss the model for end-stage liver disease (MELD) score and its dual purpose in general and transplant hepatology. As the landscape of liver disease and transplantation has evolved considerably since the advent of the MELD score, we summarise emerging concepts, methodologies, and technologies that may improve mortality prognostication in the future. Finally, we explore how these novel concepts and technologies may be incorporated into clinical practice.

Background: Acute-on-chronic liver failure (ACLF) is a recently defined entity that carries high short-term mortality. The European Association for Study of Liver (EASL) has given a different definition for ACLF and derived two scores called Chronic Liver Failure-Consortium Organ Failure (CLIF-C OF) and CLIF-C ACLF to diagnose and predict the short-term outcome, respectively. Materials and methods: This was the prospective observational study, included 40 ACLF patients diagnosed as per the EASL definition and calculated CLIF-C ACLF as well as other scores (CTP, MELD, MELD-Na, CLIF-C OF) on admission. Serial CLIF-C OF scores were also calculated (Day 3 and Day 7). The 28-day and 90-day mortality was recorded. Results: Alcohol was the predominant etiology of cirrhosis (32 patients--80%). Infection was the chief precipitating factor in 19 patients (47.5%). The 28-day and 90-day mortality was 45% and 52.5%. Mean (SD) of CLIF-C ACLF scores of survivors and non-survivors on Day-90 were 44.11(6.62) and 53.86 (7.83). The prognostic accuracy of the CLIF-C ACLF score (Area Under Receiver Operating Characteristic Curve--AUROC) to predict 28-day and 90-day mortality was 0.86 and 0.84, respectively. MELD-Na and CLIF-C ACLF scores had higher AUROC for predicting 28-day and 90-day mortality, respectively. The AUROC of the CLIF-C OF score on Day 3 was found to be higher than the values of Day 1 and Day 7, but it was not statistically significant. Conclusion: CLIF-C ACLF has good short-term prognostic accuracy and it is as good as other available scores. Serial CLIF-C OF scores were equally good in predicting in short-term mortality. [ABSTRACT FROM AUTHOR]

Objective: Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage‐indicating scores (albumin–bilirubin [ALBI], Model for End‐Stage Liver Disease [MELD], aspartate aminotransferase‐to‐platelet ratio [APRI]) and inflammatory markers (platelet‐to‐lymphocyte ratio [PLR] and neutrophil‐to‐lymphocyte ratio [NLR]). Methods: Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis. Results: Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false‐positive rate of 10%. Conclusion: This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice. [ABSTRACT FROM AUTHOR]

A review and discussion of the current literature on liver transplantation for acute-on-chronic liver failure (ACLF) was performed. The ACLF represents an acute deterioration of liver function with pre-existing liver disease and is associated with increasing multiorgan failure, depending on the stage. The 28-day mortality ranges to well over 70% in stage 3 and requires rapid intensive medical treatment involving an interdisciplinary team experienced in transplantation medicine. Under optimized conditions, liver transplantation provides long-term survival rates comparable to other indications. Achieving this requires a differentiated donor selection, choosing the appropriate time for transplantation in the context of a dynamic disease course and the use of appropriate surgical techniques. [ABSTRACT FROM AUTHOR]

Background: In individuals with terminal-stage liver disease, spontaneous peritonitis, particularly spontaneous fungal peritonitis, is a serious fatal condition. We assessed different risk variables, microbiological results, and patient outcomes in SFP patients compared to patients with spontaneous bacterial peritonitis. Objective: We aimed to evaluate the frequency and risk factors for the development of SFP in cirrhotic patients with ascites. Patients and methods: We conducted a cross-sectional study on 154 cirrhotic patients with ascites (102 males and 52 females) who were admitted to the Tropical Medicine and Gastroenterology Departments in our Hospital. The samples were sent to the clinical and chemical pathology laboratory at Sohag university hospital. Detailed history, clinical examination, ascitic fluid analysis, laboratory investigations, abdominal ultrasonography, and bacterial and fungal cultures from ascitic fluid were performed. Results: The patients were categorized into 3 groups according to the ascitic fluid analysis and the bacterial and fungal culture. The first group included 69 patients (44.5%) who were diagnosed with SBP. The second group included 15 patients (9.7%) who were diagnosed with SFP. The third group included 71 patients (45.8%) who were diagnosed with liver cirrhosis without ascitic fluid infection. As regard the bacterial and fungal culture of ascitic fluid, Escherichia coli was the most reported bacterial infection (32.7%) followed by Klebsiella pneumonia (22.4%), while Candida ciferrii was the most reported fungal infection (10.2%) followed by Candida albicans (8.2%). Conclusions: SFP is not a rare complication of liver cirrhosis with ascites. It should be considered mainly in patients with high Model of End-stage Liver Disease and Child-Turcotte-Pugh scores. [ABSTRACT FROM AUTHOR]

Acetaminophen (APAP) overdose is the leading cause of drug-induced liver injury and can cause a rapid progression to acute liver failure (ALF). Therefore, the identification of prognostic biomarkers to determine which patients will require a liver transplant is critical for APAP-induced ALF. We begin by relating the mechanistic investigations in mouse models of APAP hepatotoxicity to the human APAP overdose pathophysiology. We draw insights from the established sequence of molecular events in mice to understand the progression of events in the APAP overdose patient. Through this mechanistic understanding, several new biomarkers, such as CXCL14, have recently been evaluated. We also explore how single-cell RNA sequencing, spatial transcriptomics, and other omics approaches have been leveraged for identifying novel biomarkers and how these approaches will continue to push the field of biomarker discovery forward. Recent investigations have elucidated several new biomarkers or combination of markers such as CXCL14, a regenerative miRNA signature, a cell death miRNA signature, hepcidin, LDH, CPS1, and FABP1. While these biomarkers are promising, they all require further validation. Larger cohort studies analyzing these new biomarkers in the same patient samples, while adding these candidate biomarkers to prognostic models will further support their clinical utility. [ABSTRACT FROM AUTHOR]

Background: Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre‐liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug‐resistant microorganism (MDRO) infections before LT on survival after LT. Methods: Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients' comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post‐LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis. Results: A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had ≥1 pre‐LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was Klebsiella pneumoniae (18%); the most common MDRO was ESBL‐producing Enterobacterales (16%), and carbapenem‐resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (p =.001) and fluoroquinolone (p =.001), SBP prophylaxis (p =.03), ACLF before LT (p =.03), and days of hospital stay pre‐LT (p <.001); HCC diagnosis was protective (p =.01). Factors associated with 90‐day mortality after LT were higher MELD on inclusion to the waiting list (p =.02), pre‐LT MDRO infection (p =.04), dialysis after LT (p <.001), prolonged duration of LT surgery (p <.001), post‐LT CR‐Gram‐negative bacteria infection (p <.001), and early retransplantation (p =.004). Conclusion: MDRO infections before LT have an important impact on survival after LT. [ABSTRACT FROM AUTHOR]

Background and Aims: Model for End‐stage Liver Disease (MELD) and MELDNa are used worldwide to guide graft allocation in liver transplantation (LT). Evidence exists that females are penalized in the present allocation systems. Recently, new sex‐adjusted scores have been proposed with improved performance respect to MELD and MELDNa. GEMA‐Na, MELD 3.0, and sex‐adjusted MELDNa were developed to improve the 90‐day dropout prediction from the list. The present study aimed at evaluating the accuracy and calibration of these scores in an Italian setting. Methods: The primary outcome of the present study was the dropout from the list up to 90 days because of death or clinical deterioration. We retrospectively analysed data from 855 adults enlisted for liver transplantation in the Lazio region (Italy) (2012–2018). Ninety‐day prediction of GEMA‐Na, MELD 3.0 and sex‐adjusted MELDNa with respect to MELD and MELDNa was analysed. Brier score and Brier Skill score were used for accuracy, and the Greenwood‐Nam‐D'Agostino test was used to evaluate the calibration of the models. Results: GEMA‐Na (concordance =.82, 95% CI =.75–.89), MELD 3.0 (concordance =.81, 95% CI =.74–.87) and sex‐adjusted MELDNa (concordance =.81, 95% CI =.74–.88) showed the best 90‐day dropout prediction. GEMA‐Na showed a higher increase in accuracy with respect to MELD (p =.03). No superiority was shown with respect to MELDNa. All the tested scores showed a good calibration of the models. Using GEMA‐Na instead of MELD would potentially save one in nine dropouts and could save one dropout per 285 patients listed. Conclusions: Validation and reclassification of the sex‐adjusted score GEMA‐Na confirm its superiority in predicting short‐term dropout also in an Italian setting when compared with MELD. [ABSTRACT FROM AUTHOR]

It is well known that renal dysfunction has a devastating effect on the prognosis of liver cirrhosis. In this study, the aim was to assess whether the incorporation of the kidney dysfunction type into the MELD-Na score enhances its predictive capacity for outcomes in patients awaiting liver transplantation (LT), compared to utilizing the MELD 3.0 score with albumin. In total, 2080 patients awaiting the LT were enrolled at two tertiary care institutions in Korea. Discrimination abilities were analyzed by using Harrell's c-index and iAUC values between MELD-Na-kidney dysfunction type (MELD-Na-KT) and MELD 3.0 with albumin. Clinical endpoints encompassed 3-month survival, 3-month transplant-free survival (TFS), overall survival (OS), and total TFS. Out of the total of 2080 individuals, 669 (32.16%) were male. Regarding the types of renal function impairment, 1614 (77.6%) were in the normal group, 112 (5.38%) in the AKD group, 320 (15.35%) in the CKD group, and 34 (1.63%) were in the AKD on CKD group. MELD 3.0 with albumin showed better discrimination (c-index = 0.714) compared to MELD-Na-KT (c-index = 0.708) in predicting 3-month survival. Similar results were observed for OS, 3-month TFS, and total TFS as well. When divided by sex, MELD 3.0 with albumin showed the comparable prediction of 3-month survival to MELD-Na-KT (c-index 0.675 vs. 0.671, p-value 0.221) in males. However, in the female group, MELD 3.0 with albumin demonstrated better results compared to MELD-Na-KT (c-index 0.733 vs. 0.723, p-value 0.001). The integration of kidney dysfunction types into the MELD-Na did not yield superior prognostic results compared to the MELD 3.0 score with albumin. Rather, in the female group, the MELD 3.0 score with albumin was better able to predict survival. These findings suggest that laboratory values pertaining to liver dysfunction or creatinine levels may be more significant than the type of kidney dysfunction when predicting the short-term prognosis of LT candidates. [ABSTRACT FROM AUTHOR]

BACKGROUND: Local ablation is an important treatment for liver cancer in cases of cirrhosis. Liver failure may occur after ablation, especially in advanced liver diseases. Currently, there is no standardization for peri-interventional risk assessment. The liver maximum capacity test (LiMAx) is used to assess functional liver capacity, but there is a lack of exploration of its use in this context. OBJECTIVE: The aim of this study was to retrospectively evaluate the usefulness of peri-interventional LiMAx measurements in patients with primary or secondary liver cancer who underwent ablation treatment. METHODS: A LiMAx test was performed at 24 hours pre- and postablation in 49 patients. Blood parameters were collected to determine liver function using MELD and ALBI scores. The results of the LiMAx test were related with these scores and to critical postintervention LiMAx values. RESULTS: LiMAx values correlated strongly with MELD and ALBI scores before the intervention and reflected the change in liver function, as shown by an increase in scores after the intervention. Notably, LiMAx values decreased during the intervention. AUC analysis for patients at risk of reaching a critical liver level after the intervention showed a cutoff value of 186μg/kg/h. CONCLUSIONS: The LiMAx test may be a valuable tool in liver ablation for both peri-interventional monitoring of liver function and preintervention risk assessment. [ABSTRACT FROM AUTHOR]

COVID-19 infections accelerate liver decompensation and serious liver-related co-morbidities. The aim is to evaluate the safety and impact of COVID vaccines on hepatic disease progression in patients with advanced liver disease and to identify parameters that predict the occurrence of complications. The study involved 70 patients with advanced liver disease who were vaccinated with different COVID vaccines from January 2021 to April 2022. They were evaluated clinically. The laboratory investigation included a complete blood count, liver and kidney function tests, calculation of CTP and MELD scores, plasma levels of ammonia, abdominal ultrasound, and upper GI endoscopy. Twenty patients had experienced complications 64 ± 12 days from the last dose of a vaccination. Twenty patients (28.6%) developed hepatic decompensation and hypothyroidism (n = 11, 15.7%), and five (7.14%) patients developed splanchnic thrombosis. There were no COVID-19 reinfections except for two patients who received Sinopharm and developed vaccine-associated enhanced disease (2.9%). Complications after COVID vaccinations were correlated with ALT (r = 0.279, p = 0.019), serum sodium (r = −0.30, p = 0.005), creatinine (r = 0.303, p = 0.011), liver volume (LV) (r = −0.640, p = 0.000), and MELD score (r = 0.439, p = 0.000). Multivariate logistic regression revealed that LV is the only independent predictor (p = 0.001). LV ≤ 682.3 has a sensitivity of 95.24% and a specificity of 85.71% in predicting complications with an AUC of 0.935, p < 0.001. In conclusion, the hepatic reserve and prognosis in liver cirrhosis should be evaluated prior to COVID vaccinations using the MELD score and liver volume as promising risk stratification criteria. In summary, the research proposes a novel triaging strategy that involves utilizing the MELD score and liver volume as risk stratification parameters of the hepatic reserve and prognosis of advanced liver cirrhosis prior to COVID immunization to determine who should not receive a COVID vaccination. [ABSTRACT FROM AUTHOR]

The severity of liver functional reserve is an important prognostic predictor in hepatocellular carcinoma (HCC). The albumin–bilirubin (ALBI), easy (EZ)-ALBI, platelet-albumin–bilirubin (PALBI), platelet–albumin (PAL) score, and MELD 3.0 score are used to evaluate the severity of liver dysfunction. However, their prognostic role in HCC patients, specifically with renal insufficiency (RI), is unclear. We aimed to investigate the predictive accuracy of the five models in these patients. A total of 1120 newly diagnosed HCC patients with RI were enrolled. A multivariate Cox proportional analysis was used to identify independent predictors associated with survival. In the Cox model, older age, an α-fetoprotein ≥20 ng/mL, vascular invasion, a medium and high tumor burden score, poor performance status, a higher ALBI grade, an EZ-ALBI grade, a PALBI grade, a PAL grade, and MELD 3.0 score were all independently associated with decreased overall survival (all p < 0.001). Among the five liver reserve models, the ALBI grade is the best surrogate marker to represent liver functional reserve in terms of outcome prediction. The albumin-based liver reserve models (ALBI, EZ-ALBI, PALBI, and PAL) and MELD 3.0 are all feasible prognostic markers to indicate liver injury, specifically in HCC patients with RI. Among them, the ALBI grade is the most robust tool for survival prediction in these patients. [ABSTRACT FROM AUTHOR]

Emotion recognition is crucial in artificial intelligence, particularly in the domain of human–computer interaction. The ability to accurately discern and interpret emotions plays a critical role in helping machines to effectively decipher users' underlying intentions, allowing for a more streamlined interaction process that invariably translates into an elevated user experience. The recent increase in social media usage, as well as the availability of an immense amount of unstructured data, has resulted in a significant demand for the deployment of automated emotion recognition systems. Artificial intelligence (AI) techniques have emerged as a powerful solution to this pressing concern in this context. In particular, the incorporation of multimodal AI-driven approaches for emotion recognition has proven beneficial in capturing the intricate interplay of diverse human expression cues that manifest across multiple modalities. The current study aims to develop an effective multimodal emotion recognition system known as MM-EMOR in order to improve the efficacy of emotion recognition efforts focused on audio and text modalities. The use of Mel spectrogram features, Chromagram features, and the Mobilenet Convolutional Neural Network (CNN) for processing audio data are central to the operation of this system, while an attention-based Roberta model caters to the text modality. The methodology of this study is based on an exhaustive evaluation of this approach across three different datasets. Notably, the empirical findings show that MM-EMOR outperforms competing models across the same datasets. This performance boost is noticeable, with accuracy gains of an impressive 7% on one dataset and a substantial 8% on another. Most significantly, the observed increase in accuracy for the final dataset was an astounding 18%. [ABSTRACT FROM AUTHOR]

Background and Aims: Living liver donation with high model for end‐stage liver disease (MELD) score was discouraged despite organ shortage. This study aimed to compare graft survival between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) recipients with extremely high‐MELD (score of ≥35). Methods: Between 2008 and 2018, 359 patients who underwent liver transplantation with a MELD score ≥35 were enrolled. We compared graft survival between LDLT and DDLT after propensity score matching (PSM) and performed subgroup analysis according to donor type. Results: After PSM, there was no statistical difference in graft survival between the LDLT and DDLT groups (p =.466). Old age, acute on chronic liver failure, re‐transplantation, preoperative intensive care unit stay and red blood cell (RBC) transfusion during the operation were risk factors for graft failure (p =.046,.005,.032,.015 and.001, respectively). Biliary complications were more common in the LDLT group (p =.021), while viral infection, postoperative uncontrolled ascites, and postoperative hemodialysis were more common in the DDLT group (p =.002,.018, and.027, respectively). In the LDLT group, acute chronic liver failure, intraoperative RBC transfusion, and early postoperative complications were risk factors for graft failure (p =.007, <.001, and.001, respectively). Conclusion: Our study showed that LDLT is not inferior to DDLT in graft survival if appropriate risk evaluation is performed in cases of extremely high‐MELD scores. This result will help overcome organ shortages in high‐MELD liver transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Alcoholic hepatitis is a major health problem which carries a high mortality despite treatment. Predicting severity of disease is of utmost importance to avoid overzealous and unnecessary treatment with steroids in each and every case. Maddrey’s discriminant function (DF) may not always be reliable in predicting such prognosis. Aim of the Study: To observe the predictive ability of Glasgow alcoholic hepatitis score (GAHS), age, bilirubin, international normalized ratio (INR) and creatinine (ABIC) score, model for end stage liver disease (MELD) score, and Lille’s score in determining the prognosis in severe alcoholic hepatitis. Materials and Methods: Patients of severe alcoholic hepatitis were enrolled in this study as per inclusion and exclusion criteria and a DF score of >32. Once the decision to initiate corticosteroids was made, DF scores, MELD scores, GAHS scores, and ABIC scores were calculated on the day on initiation of therapy. On day 7, patients were re-assessed and Lille score was calculated in addition. Follow-up was obtained on repeat out-patient visit or telephonically after every 2 weeks till 90 days or till mortality, whichever occurred first. Statistical Analysis: The scores were compared among the survival and mortality groups to see association between mortality and severity of scores using Chi-square test of significance. Cut-offs providing a composite of best sensitivity, specificity, negative predictive value, and positive predictive value were derived on the basis of data of our study. P value of ≤ 0.05 was taken as a cut-off for significance. Results: Our study comprised 30 patients with severe alcoholic hepatitis. At the end of 90-day follow-up, 23 patients survived with 7 (23%) mortalities because of liver failure and sepsis. On day 7, barring the ABIC score (0.713), the areas under curve of all scores were above 0.8 and were hence of comparable efficacy. Lille score performed the best at assessing treatment response but had the limitation of not being applicable at day 1. Conclusion: Severe alcoholic hepatitis carries a bad prognosis. Cut-offs of DF and MELD need to be raised, whereas they need to be lowered in the case of GAHS, ABIC, and Lille score to improve the predictive value of score. Steroid-treated patients should be evaluated preferably with Lille score for a better prediction of survival.

Background/Aims: The MELD score is a scoring system used to assess the severity of end-stage liver disease. In our study, we aimed to investigate the role of MELD score in predicting the course of the disease and mortality in COVID-19 disease with multi-systemic involvement. Methods: Our study was conducted with 96 patients over the age of 18 who were diagnosed with COVID-19 by real time PCR method by taking nasopharyngeal swabs between March 2021 and March 2022. MELD score was calculated according to the blood results of the patients at the time of hospital admission. To calculate the MELD score, the equation MELD = 11.2 x ln(international normalized ratio [INR]) + 3.78 x ln(bilirubin, mg/dL) + 9.57 x ln(creatinine, mg/dL) + 6.43 was used. Results: We found that the MELD score was significantly higher in the moderate and severe patient group compared to the mild patient group (p

Introduction: Hyponatremia is a prevalent electrolyte disturbance observed in individuals diagnosed with liver cirrhosis. This condition is closely linked to unfavorable prognostic outcomes and the development of complications such as hepatorenal syndrome and ascites. Methods: The selection of patients was based on a comprehensive evaluation that included clinical examination, biochemical tests, and ultrasound examination of the abdomen. Upon admission to the hospital, all patients underwent a comprehensive examination, which included the assessment of their serum sodium levels. Throughout their hospitalization, the patients were closely monitored and their progress was observed. The assessment of the severity of cirrhosis was conducted based on the Child-Pugh score. The MELD score and MELD-Na score were computed upon admission. Results: A study was conducted on a cohort of 150 patients diagnosed with cirrhosis, revealing that the predominant cause of cirrhosis in this particular investigation was attributed to alcohol consumption. A total of 53% of the participants exhibited hyponatremia, defined as a serum sodium concentration below 136 meq/l. The incidence of complications associated with cirrhosis was found to be higher among patients with hyponatremia. Statistically significant findings indicate that complications such as portal hypertension (57%), hepatic encephalopathy (89.28%), hepatorenal syndrome (42.8%), and hyponatremia are prevalent among patients with cirrhosis. The scores for Child-Pugh, Model for End-Stage Liver Disease (MELD), and MELD-Na are elevated in cases of hyponatremia. Mortality is also observed to be more prevalent in cases of severe hyponatremia. Conclusion: Dilutional hyponatremia is a common occurrence among individuals with cirrhosis, and it is often linked to the development of serious complications associated with liver cirrhosis, such as hepatic encephalopathy and hepatorenal syndrome. The presence of hyponatremia in individuals with cirrhosis is also linked to increased morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Prognostic models proposed for cirrhotic patients' survival have not been satisfactorily investigated in the Vietnam population, especially in the medium-term period. PATIENTS AND METHODS: In this prospective study, we enrolled a total of 904 patients admitted to Hepato-Gastroenterology Center, Bach Mai Hospital from December 2019 to November 2021 and calculated their CP, MELD, MELD-Na score, IMELD, Refit MELD, and Refit MELD-Na after 2-year follow-up to compare their survival prognosis. RESULTS: The mean age of the patients was 53.8 ±10.8 years, and males constituted 91%. Compared with the surviving group, deceased patients had statistically significant lower albumin, higher INR, serum bilirubin, and creatinine levels with higher means of all prognostic scores. RefitMELD score had the highest AUC (0.768), followed by MELD (0.766), and the lowest belonged to RefitMELDNa (0.669). CONCLUSIONS: In conclusion, deceased patients had significantly higher values of Child-Pugh score and all MELD-based scores than survival. RefitMELD is the most reliable scoring system to predict 2-year mortality in patients with decompensated liver cirrhosis. [ABSTRACT FROM AUTHOR]

Synthesis of plasma proteins is an important function of the liver that has sparsely been investigated by modern techniques in patients with advanced chronic liver disease (CLD). Twenty-eight well-characterized patients with CLD under evaluation for liver transplantation were included. Albumin and fibrinogen synthesis rates were measured by the flooding dose technique using stable isotope-labeled phenylalanine. Transcapillary escape rate of albumin and plasma volume were assessed by radioiodinated human serum albumin. The absolute albumin synthesis rates were low (65 mg/kg/day, range: 32-203) and were associated with impaired liver function, as reflected by the risk-scores Child-Pugh (P = 0.025) and model for end-stage liver disease (rs = -0.62, P = 0.0005). The fibrinogen synthesis rate (12.8 mg/kg/day, range: 2.4-52.9) was also negatively associated with liver function. The synthesis rates of albumin and fibrinogen were positively correlated. Plasma volume was high (51 ± 9 mL/kg body wt), which contributed to an almost normal intravascular albumin mass despite low plasma concentration. Autoimmune inflammatory etiologies to CLD were associated with higher fibrinogen synthesis. De novo synthesis rates of albumin and fibrinogen in advanced chronic liver failure were negatively correlated to prognostic scores of liver disease. Albumin synthesis rate was low and associated with both liver failure and autoimmune inflammation, whereas fibrinogen synthesis was often normal and positively associated with chronic inflammation. This is different from acute inflammatory states in which both albumin and fibrinogen synthesis rates are high. [ABSTRACT FROM AUTHOR]

Background: Cirrhosis detection in primary care relies on low-performing biomarkers. Consequently, up to 75% of subjects with cirrhosis receive their first diagnosis with decompensation when causal treatments are less effective at preserving liver function. We investigated an unprecedented approach to cirrhosis detection based on dynamic breath testing. Methods: We enrolled 29 subjects with cirrhosis (Child–Pugh A and B), and 29 controls. All subjects fasted overnight. Breath samples were taken using Breath Biopsy® before and at different time points after the administration of 100 mg limonene. Absolute limonene breath levels were measured using gas chromatography–mass spectrometry. Results: All subjects showed a >100-fold limonene spike in breath after administration compared to baseline. Limonene breath kinetics showed first-order decay in >90% of the participants, with higher bioavailability in the cirrhosis group. At the Youden index, baseline limonene levels showed classification performance with an area under the roc curve (AUROC) of 0.83 ± 0.012, sensitivity of 0.66 ± 0.09, and specificity of 0.83 ± 0.07. The best performing timepoint post-administration was 60 min, with an AUROC of 0.91, sensitivity of 0.83 ± 0.07, and specificity of 0.9 ± 0.06. In the cirrhosis group, limonene bioavailability showed a correlation with MELD and fibrosis indicators, and was associated with signs of portal hypertension. Conclusions: Dynamic limonene breath testing enhances diagnostic performance for cirrhosis compared to static testing. The correlation with disease severity suggests potential for monitoring therapeutic interventions. Given the non-invasive nature of breath collection, a dynamic limonene breath test could be implemented in primary care. [ABSTRACT FROM AUTHOR]

Alcohol‐associated liver disease is the primary cause of liver‐related mortality worldwide and one of the most common indications for liver transplantation. Alcoholic hepatitis represents the most acute and severe manifestation of alcohol‐associated liver disease and is characterized by a rapid onset of jaundice with progressive inflammatory liver injury, worsening of portal hypertension, and an increased risk for multiorgan failure in patients with excessive alcohol consumption. Severe alcoholic hepatitis is associated with a poor prognosis and high short‐term mortality. During the COVID‐19 pandemic, rates of alcohol‐associated hepatitis have increased significantly, underscoring that it is a serious and growing health problem. However, adequate management of alcohol‐associated hepatitis and its complications in everyday clinical practice remains a major challenge. Currently, pharmacotherapy is limited to corticosteroids, although these have only a moderate effect on reducing short‐term mortality. In recent years, translational studies deciphering key mechanisms of disease development and progression have led to important advances in the understanding of the pathogenesis of alcoholic hepatitis. Emerging pathophysiology‐based therapeutic approaches include anti‐inflammatory agents, modifications of the gut‐liver axis and intestinal dysbiosis, epigenetic modulation, antioxidants, and drugs targeting liver regeneration. Concurrently, evidence is increasing that early liver transplantation is a safe treatment option with important survival benefits in selected patients with severe alcoholic hepatitis not responding to medical treatment. This narrative review describes current pathophysiology and management concepts of alcoholic hepatitis, provides an update on emerging treatment options, and focuses on the need for holistic and patient‐centred treatment approaches to improve prognosis. [ABSTRACT FROM AUTHOR]

Background and aims: Different modes of artificial liver support (ALS) therapy can improve the survival of patients with acute-on-chronic liver failure (ACLF). This study aimed to compare the effects of mixed using different modes of ALS (MALS) and single using one mode of ALS (SALS) on 28- and 90-day survival rates of ACLF. Methods: Clinical data and survival times of patients with ACLF treated for ALS between January 1, 2018 and December 30, 2021 were retrospectively collected. Cox regression analysis was performed to identify risk factors of 28- and 90-day mortalities. Results: Of the 462 eligible ACLF patients, 388 belonged to the SALS group (76.3% male, 74.2% cirrhosis) and 74 to the MALS group (86.5% male, 71.6% cirrhosis). Comparison of 28-day and 90-day crude mortality between the SALS and MALS groups showed no significant differences (28-day: 20.4% vs. 14.9%, p = 0.27; 90-day: 44.6% vs. 52.7%, p = 0.20). After adjusting for confounders, the 28-day mortality (adjusted hazard ratio [aHR]: 0.32, 95% confidence interval [CI] 0.16–0.65) and 90-day mortality (aHR: 0.65, 95% CI 0.44–0.95) in the MALS group were significantly lower than those in the SALS group. These associations were consistently observed across pre-specified subgroups according to age, sex, etiology, and Child–Pugh grade. However, positive interactions between MALS and 90-day mortality were found between MALS and 90-day mortality in those with MELD score ≥ 22 and international normalized ratio ≥ 1.9 (p for interaction < 0.05). Conclusion: MALS therapy significantly decreased 28- and 90-day mortalities of ACLF than SALS did, especially in advanced stages. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation (LT) is associated with excellent survival in patients with acute-on-chronic liver failure (ACLF). There is a lack of data assessing the healthcare utilization and outcomes of patients with APASL-defined ACLF undergoing living donor liver transplantation (LDLT). Our aim was to assess pre-LT healthcare utilization and post-LT outcomes in such patients. Methods: Patients with ACLF who underwent LDLT at our center between 1st April 2019 and 1st October 2021 were included. Results: Seventy-three ACLF patients willing to undergo LDLT were listed; eighteen patients died within 30 days. Fifty-five patients underwent LDLT (age:38.05 ± 14.76 years; alcohol:52.7%; males:81.8%). Most were in grade II ACLF (87.3%) at the time of LDLT (APASL ACLF Research Consortium [AARC] score: 9.05 ± 1; MELD NA: 28.15 ± 4.13). Survival rate was 72.73%; mean follow-up period of 925.21 days; 58.2% (32/55) developed complications during the first year post-LT; 45% (25/55) and 12.7% (7/55) developed infections within and after 3 months. Pre-LT, each patient required a median of 2 (1–4) admissions for 17 (4–45) days. Fifty-six percent (31/55) of patients underwent plasma exchange pre-LDLT. A median amount of Rs. 8,25,090 (INR 26,000–43,58,154) was spent to stabilize the patient (who were sicker and waited longer to undergo LDLT); though post-LT survival benefit was not observed. Conclusions: LDLT was associated with 73% survival and, thus, is a viable option in those with APASL-defined ACLF. There was a pre-LT high healthcare resource utilization of plasma exchange, with the intention of optimization, while survival benefit has not been demonstrated. [ABSTRACT FROM AUTHOR]

Aim: Heavy alcohol consumption is the most common etiology of acute-on-chronic liver failure (ACLF) in Japan. In some patients, ACLF is associated with a fatal outcome in less than 6 months. We evaluated the prognosis of patients with alcohol-related ACLF in our cohort and explored the prognostic factors. Methods: Forty-six patients with alcoholic liver cirrhosis who fulfilled the Japanese diagnostic criteria for ACLF, including those classified as extended and/or probable, were enrolled in this study. Serum concentrations of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were measured. We assessed prognosis and identified factors associated with survival. Results: During the median 33-day observation period, 19 patients died, and 3 patients underwent living donor liver transplantation. Cumulative survival rates of patients treated without liver transplantation were 69, 48, 41, and 36% at 1, 3, 6, and 12 months, respectively. Eighteen of the 19 deceased patients died within 6 months after ACLF diagnosis. Serum concentrations of inflammatory cytokines were significantly elevated, and patients who underwent liver transplantation or who died within 6 months after admission had significantly higher serum IL-6 levels than the survival group. Multivariate analysis identified IL-6 > 23.3 pg/mL at admission and model for end-stage liver disease (MELD) score ≥ 25 on day 4 of admission as significant independent factors for mortality within 6 months. Conclusion: Serum IL-6 level and Day-4 MELD were prognostic factors for alcohol-related ACLF. Early liver transplantation is a potential treatment option for patients whose prognosis is expected to be poor. [ABSTRACT FROM AUTHOR]

The outcome of the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) is also influenced by the renal and hepatic organ functions. Risk stratification, using scores such as EURO Score II or STS Short-Term Risk Calculator for patients undergoing cardiac surgery with cardiopulmonary bypass, ignores the quantitative renal and hepatic function; therefore, MELD-Score was applied in these cases. We retrospectively examined patient data using the MELD score as a predictor of mortality. To perform a univariate analysis of the data, patients were classified into three groups based on the MELD Score: MELD < 10 (Group 1), MELD 10 to 19 (Group 2), and MELD ≥ 20 (Group 3). A total of 11,477 participants were included in the study, though several patients with either missing MELD scores or lack of creatinine, bilirubin, or INR levels were dropped from the original cohort. Eventually, 10,882 patients were included in the analysis. The primary outcome was defined as postoperative, in-hospital mortality. Secondary outcomes such as postoperative bleeding, including the requirement for repeat thoracotomy, postoperative neurological complications, and assessment of catecholamines on weaning from cardiopulmonary bypass/ requirement of mechanical circulatory support were examined. A higher MELD score was associated with increased postoperative mortality. Patients with MELD > 20 experienced a 31.2% postoperative mortality, compared to Group 1 (4.6%) and Group 2 (17.5%). The highest rates of postoperative bleeding (13.8%) and, repeat thoracotomy (13.2%) & postoperative pneumonia (17.4%) were seen in Group 3 (threefold increase when compared to Group 1, renal failure requiring dialysis (N = 235, 2.7% in Group 1 v/s N = 78, 22.9% in Group 3) or requiring high dose catecholamines post-operatively or mechanical circulatory support (IABP/ECLS). Incidentally, an increased MELD Score was not associated with a significant increase in the postoperative incidence of stroke/TIA or the presence of sternal wound infections/complications. A higher mortality was observed in patients with reduced liver and renal function, with a significant increase in patients with a MELD score > 20. As the current risk stratification scores do not consider this, we recommend applying the MELD score before considering patients for cardiac surgery. [ABSTRACT FROM AUTHOR]

Acute liver failure (ALF) is a major success story in gastroenterology, with improvements in critical care and liver transplant resulting in significant improvements in patient outcomes in the current era compared to the dismal survival rates in the pretransplant era. However, the ever-increasing list of transplant candidates and limited organ pool makes judicious patient selection and organ use mandatory to achieve good patient outcomes and prevent organ wastage. Several scoring systems exist to facilitate the identification of patients who need a liver transplant and would therefore need an early referral to a specialized liver unit. The timing of the liver transplant is also crucial as transplanting a patient too early would lead to those who would recover spontaneously receiving an organ (wastage), and a late decision might result in the patient becoming unfit for transplant (delisted) or have an advanced disease which would result in poor post-transplant outcomes. The current article reviews the indications and contraindications of liver transplant in ALF patients, the various prognostic scoring systems, etiology-specific outcomes, prioritization and timing of referral. [ABSTRACT FROM AUTHOR]

Introduction: Currently in the United States, deceased donor liver transplant (DDLT) allocation priority is based on the model for end-stage liver disease including sodium (MELD-Na) score. The United Network for organ sharing's 'Share-15' policy states that candidates with MELD-Na scores of 15 or greater have priority to receive local organ offers compared to candidates with lower MELD-Na scores. Since the inception of this policy, major changes in the primary etiologies of end-stage liver disease have occurred and previous assumptions need to be recalibrated. Methods: The authors retrospectively analyzed the Scientific Registry of Transplant Recipients database between 2012 and 2021 to determine life years saved by DDLT at each interval of MELD-Na score and the time-to-equal risk and time-to-equal survival versus remaining on the waitlist. The authors stratified our analysis by MELD exception points, primary disease etiology, and MELD score. Results: On aggregate, compared to remaining on the waitlist, a significant 1-year survival advantage of DDLT at MELD-Na scores as low as 12 was found. The median life years saved at this score after a liver transplant was estimated to be greater than 9 years. While the total life years saved were comparable across all MELD-Na scores, the time-to-equal risk and time-to-equal survival decreased exponentially as MELD-Na scores increased. Conclusion: Herein, the authors challenge the perception as to the timing of DDLT and when that benefit occurs. The national liver allocation policy is transitioning to a continuous distribution framework and these data will be instrumental to defining the attributes of the continuos allocation score. [ABSTRACT FROM AUTHOR]