A #livertwitter #tweetorial
Let's go deep to the very first prognostic tools
& see how everything old is new again.
Keywords: Child class, MELD, Frailty
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What is the expected transplant-free survival for a person with a recent diagnosis of #cirrhosis?
3 main developments since Child-Pugh:
1⃣Stats goes pro. Cox describes the hazard ratio,1972. Hepatologists use it to model predictors(Fig1)
2⃣@Mayoclinic pubs series of prognostic models🔼focus on purely OBJECTIVE data(Fig2)
3⃣Hello, TIPS!(Fig3)
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MELD gave us: 🔼risk stratification 4 ChildC, objective transplant allocation
Unsolved: Risk discrim 4 Child A. Median survival 12yrs w/range 10-20y!!(Fig2)
Problem: Most pts w/#cirrhosis r Child A
Future: Predicting decompensation e.g. aasldpubs.onlinelibrary.wiley.com/doi/abs/10.100…
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⭐️Portosystemic shunt surgery/TIPS spurred risk score development(Child, MELD)
⭐️Child=stable(10yrs) vs sick(1-2y)
⭐️Prognosis if decompensated=MELD
⭐️Child class had 'nutritional status' and HE; MELD doesnt. But factors like HE, disability, frailty are a/w mortality