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      Clinical impact of the Model for End Liver Disease (MELD) score on the presence of microvascular invasion and on the postoperative outcome in patients undergoing liver transplantation Translated title: Impacto clínico do Model For End Liver Disease (MELD) na presença de invasão microvascular e no desfecho pós-operatório em pacientes submetidos a transplante hepático

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          ABSTRACT

          Objective:

          to correlate clinical and epidemiological data with the pathological analysis of liver explants from patients undergoing liver transplantation for hetapocarcinoma in the UNICAMP HC and to verify whether the MELD and MELD-Na scores are reliable factors to predict a worse post-transplant prognosis.

          Methods:

          we studied liver transplants carried out between May 2010 and November 2017. After excluding 38 patients, we included 87, analyzing clinical and laboratory data for correlation with the outcome Microvascular Invasion (MVI). Subsequently, we computed the MELD and MELD-Na scores and performed a descriptive analysis of clinical and laboratory data and, finally, calculated ROC curves to assess the association between these laboratory parameters and mortality in these patients.

          Results:

          most patients were male (78.30%), with an average age of 58.53 years. Most liver diseases were caused by HCV (53.26%). We found no predictors for MVI among the laboratory parameters. The ROC curves for death identified the MELD score as the cutoff point with the highest combined sensitivity (90.91%) and specificity (37.50%), with a value of 10 points, whereas in the MELD-Na the cutoff point was 7 points, with a sensitivity of 90.91% and a specificity of 33.33%, both scores being significant.

          Conclusions:

          there were no reliable predictors of MVI between clinical, laboratory, and epidemiological variables. The MELD-Na score is more sensitive than the MELD one for predicting mortality in patients undergoing liver transplantation.

          RESUMO

          Objetivo:

          correlacionar dados clínicos e epidemiológicos com a análise patológica dos explantes hepáticos dos pacientes submetidos ao transplante hepático por hetapocarcinoma no HC da UNICAMP e verificar se os scores MELD e MELD-Na apresentam diferenças estatísticas para predizer pior prognóstico pós-transplante.

          Métodos:

          considerando os transplantes hepáticos ocorridos entre maio/2010 e novembro/2017, após excluir 38, 87 pacientes foram incluídos, analisando-se dados clínicos e laboratoriais desses pacientes para verificar se há independência entre esses e desfecho Invasão Microvascular (IMV). Posteriormente, realizou-se o cálculo do MELD e MELD-Na, a análise descritiva dos dados clínicos e laboratoriais e, por fim, curvas ROC para avaliar a associação entre esses parâmetros laboratoriais e o desfecho óbito nestes pacientes.

          Resultados:

          a maior parte dos pacientes foi do sexo masculino (78,30%), com idade, em média, de 58,53 anos. A maior parte das hepatopatias foi causada pelo VHC (53,26%). Não foi encontrado preditores para o desfecho IMV entre os parâmetros laboratoriais. As curvas ROC para o desfecho óbito identificaram o score MELD como ponto de corte de maior sensibilidade (90,91%) e especificidade (37,50%) simultâneas com o valor de 10 pontos, ao passo que no MELD-Na o ponto de corte foi 7 pontos, com sensibilidade de 90,91% e especificidade de 33,33%, sendo ambas as escalas significativas.

          Conclusões:

          não foram encontrados preditores para IMV entre critérios clínicos, laboratoriais e epidemiológicos. O score MELD-Na é mais sensível que o MELD para predizer mortalidade nos pacientes submetidos a transplante hepático.

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          Most cited references33

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          Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

          The combination of atezolizumab and bevacizumab showed encouraging antitumor activity and safety in a phase 1b trial involving patients with unresectable hepatocellular carcinoma.
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            Hepatocellular Carcinoma

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              Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

              Background While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain. Methods We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015. Results In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates. Conclusions The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.
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                Author and article information

                Journal
                Rev Col Bras Cir
                Rev Col Bras Cir
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Colégio Brasileiro de Cirurgiões
                0100-6991
                1809-4546
                10 December 2021
                2021
                : 48
                : e20212997
                Affiliations
                [1 ] - PUC Goiás, Departamento de Medicina - Goiânia - GO - Brasil
                [2 ] - Universidade Estadual De Campinas (UNICAMP), Hospital das Clínicas da Universidade Estadual de Campinas (HC UNICAMP) - Campinas - SP - Brasil
                Author notes
                Mailing address: Leandro Augusto Rodrigues Santos E-maill: leandro_augustogyn@ 123456icloud.com

                Conflict of interest: no.

                Author information
                http://orcid.org/0000-0002-0930-8699
                Article
                00239
                10.1590/0100-6991e-20212997
                10683444
                34932735
                ecdb91b4-52a9-4746-be21-3a60142e5ee8
                © 2021 Revista do Colégio Brasileiro de Cirurgiões

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 09 March 2021
                : 30 June 2021
                Page count
                Figures: 4, Tables: 10, Equations: 0, References: 32
                Categories
                Original Article

                liver neoplasms,hepatic cirrhosis,liver transplant,neoplasias hepáticas,cirrose hepática,transplante de fígado

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