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Journal of Postgraduate Medicine, Vol. 54, No. 1, January-March, 2008, pp. 61-62 Letter Model for end-stage liver disease and outcome of portosystemic encephalopathy Khurram M, Ahmed K, Arshad MM, Khar HB, Hasan Z Department of Medicine, Rawalpindi Medical College, Rawalpindi Code Number: jp08025 Sir, The burden of hepatitis C virus (HCV)-related chronic liver disease is on the increase in Pakistan. [1] Portosystemic encephalopathy (PSE) is one of important complications of chronic liver disease (CLD). Prognostic evaluation of patients with PSE complicating HCV-related CLD is important for the treating physician as about 15% patients are alive three years after first episode of PSE. [2] Model for end-stage liver disease (MELD) is one of the scoring systems developed to predict survival in patients with CLD. It is based on easily available laboratory tests and can be measured by a calculator or through internet. An exploratory study was conducted at the Rawalpindi General Hospital to note the relationship between the MELD score at hospital admission and three months outcome, in patients with PSE complicating HCV-related CLD. The theme of the study came from the observation that such patients with higher MELD score had worse prognosis. Sixty adult patients were inducted. Patients were treated according to standard guidelines of PSE management. [3] The MELD score at admission was calculated using formula: 10{0.957 natural logarithm (serum creatinine) + 0.378 natural logarithm (total bilirubin) + 1.12 natural logarithm (INR) + 0.643}. Three months outcome was noted as improved (complete recovery or improvement in PSE stage) or deteriorated (no recovery/improvement, death). To note the relationship between MELD and outcome, patients were divided into two groups according to their MELD score i.e. Group I (MELD score < 25) and Group II (MELD score ≥25). Fisher′s exact test was used for p value calculation. Group I consisted of 42 (70%) and Group II, 18 (30%) patients. Forty-one (97.6%) patients of Group I and nine (50%) Group II patients improved while the rest deteriorated. The MELD score at admission with value ≥25 had significant relationship with poor outcome of PSE, p value < 0.01. These results are indicative of the fact that patients who improved or deteriorated had comparatively lower or higher serum creatinine levels, INR scores and serum bilirubin levels. [4] According to my knowledge, this kind of relationship between MELD score and outcome of PSE has not been noted previously. Three points need to be stressed in this regard: 1) MELD score was used as a discrete variable, 2) simplified statistical analysis was used and 3) study sample comprised patients with single CLD etiology i.e. HCV. It is recommended that MELD score should be performed in HCV-related CLD patients with PSE at admission and patients with score value ≥ 25 given additional care. Acknowledgment Dr. Khushnood Ejaz, Dr. M Arshad Mian helped during various stages of study. Professor Bushra Khar encouraged and helped a lot.References
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