Bachground/Aim: Hepatorenal syndrome (HRS) is the most serious complication in those with end stage cirrhotic liver . Renal arterial resistive index (RRI) by Duplex Doppler Ultrasonography (US) proved to be useful in predicting progression into the HRS. The addition of Na to model for end stage liver disease (MELD) score improves its predictive accuracy for assessment of patients with advanced cirrhosis. Our objective was to assess the value of, and prognostic ability of standard MELD with its 6 alternative scores and RRI in detecting impairment of renal function in ascetic cirrhotic patients and its possible use in early detection of patients at risk of developing HRS.
Methods: Sixty one patients with liver cirrhosis and refractory ascites were divided into two groups: Group I (31 patients with HRS) & group II (30 patients without HRS). Demographic, clinical & laboratory criteria were collected, abdominal US was done, and Child-Turcotte-Pugh (CTP) and MELD scores were calculated.
Results: All CTP, MELD, uMELD and serum Na based MELD scores – MELD Na, MESO, MELD-Na, iMELD and UKELD – were higher in Group I than Group II with P value (0.000) for all. In diagnosis of HRS, MESO score gave the highest AUC of 94.5% & NPV 89.3% and sharing highest sensitivity (90.3%) with MELD Na. and MELD Na represented the same AUC but there was better sensitivity and NPV with MELD Na, while MELD score gave the highest specificity (93.3%) and PPV (92.86%) among all MELD alternatives. Meanwhile RRI was not significant with lower sensitivity, specificity, PPV, NPV, and overall accuracy. By multivariate analysis of variables, the presence of encephalopathy, low diastolic pressure, higher INR, CTP, MELD-Na and uMELD scores were independent predictors of HRS.
Conclusion: Among the MELD-based scores only MELD-Na and uMELD can predict the development of HRS but when used as a diagnostic test MESO score was the best but the renal arterial RI is not promising to be used as specific marker for renal damage. |
