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 18 January 2018

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News

MELD score predicts liver failure after acetaminophen poisoning

Model for end-stage liver disease score may predict fulminant hepatic failure in patients with acetaminophen toxicity, report doctors in the latest Hepatology.

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The model for end-stage liver disease (MELD) scoring system has been established as a reliable measure of short-term mortality risk for end-stage chronic liver disease.

Drs Lars Schmidt and Fin Stolze Larsen from Denmark evaluated the prognostic value of this scoring system as a predictor of fulminant hepatic failure and death in patients with acetaminophen poisoning.

A MELD score of 33 after hepatic encephalopathy onset had a sensitivity of 60%
Hepatology

The researchers prospectively performed serial measurements of the 3 MELD components in 460 patients with acetaminophen-induced liver injury.

The 3 components included international normalized ratio, bilirubin, and creatinine.

Starting on the first day after the day of overdose, model for end-stage liver disease score was higher in patients who developed hepatic encephalopathy.

The team found that hepatic encephalopathy developed in 63 of 142 patients with a model for end-stage liver disease score above 18 at 48 to 72 hours after overdose.

The researchers noted that hepatic encephalopathy developed in 2 of 182 patients with a model for end-stage liver disease score of 18 or below after the overdose.

The research team reported a positive predictive value of 44%, and negative predictive value 99%.

In patients with fulminant hepatic failure, a threshold MELD score of 33 on the day after the onset of hepatic encephalopathy had sensitivity of 60%.

The team found that a threshold MELD score of 33 after hepatic encephalopathy onset in patients with fulminant hepatic failure had a specificity of 69%.

The researchers observed a positive predictive value of 65%, and negative predictive value of 63% in this group.

However, the discriminative power of the MELD score was not superior to that of international normalized ratio alone, or of the King's College Hospital criteria.

Dr Schmidt and colleague concluded, “Model for end-stage liver disease score may be useful as a predictor of fulminant hepatic failure in patients admitted with acetaminophen toxicity.”

“However, as a predictor of death from fulminant hepatic failure, model for end-stage liver disease score did not provide more information than the King's College Hospital criteria or international normalized ratio alone.”

Hepatology 2007: 45(3): 789-96
20 March 2007

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