Perm Medical JournalPerm Medical Journal0136-14492687-1408Eco-Vector789510.17816/pmj34640-44Research ArticlePOSSIBILITIES OF USING MELD SCALE FOR DETERMINING HEPATIC CIRRHOSIS DEGREE OF SEVERITYPaduchevaS. V.paducheva_sv@mail.ruBulatovaI. A.paducheva_sv@mail.ruSchekotovaA. P.paducheva_sv@mail.ruTretyakovaYu. I.paducheva_sv@mail.ruSchekotovaI. V.paducheva_sv@mail.ruAcademician Ye.A. Vagner Perm State Medical University15122017346404408022018Copyright © 2017, Paducheva S.V., Bulatova I.A., Schekotova A.P., Tretyakova Y.I., Schekotova I.V.2017<p><strong>Aim.</strong> To study the possibility of using MELD scale for determining the degree of severity of hepatic cirrhosis (HC) and determine its diagnostic characteristics.</p>
<p><strong>Materials and methods.</strong> Thirty patients with HC, including 15 patients with compensated HC stage (class A+B) by Child-Pugh scale and 15 persons with decompensated HC (class C), were examined. Total blood bilirubin and creatinine concentrations were assessed, INR and MELD index were calculated.</p>
<p><strong>Results.</strong> Meld index with use of total bilirubin, creatinine indices and INR is increasing as HC is progressing from 5 at the compensated stage to 26 at the decompensated stage ( p 0,001) and directly correlates with the degree of severity of cirrhosis, estimated by Child-Pugh scale ( r = 0,64; p = 0,005). The threshold value of MELD index to differentiate the compensated HC stage from the decompensated one was 11.</p>
<p><strong>Conclusions.</strong> Design parameter of MELD permits to differentiate the degrees of HC severity with sensitivity equal to 73,3 % and specificity - 84,6 %. When MELD index is less than or equal to 11, the compensated stage of HC is diagnosed, when it exceeds 11, the decompensated cirrhosis is specified.</p>Hepatic cirrhosiscirrhosis degree of severityMELD scaleChild-Pugh scaleЦирроз печенистепень тяжести циррозашкала MELDшкала Child-Pugh[1. Бессонова Е.Н., Кокина К.Ю. Современные возможности оценки тяжести состояния и прогноза жизни больных циррозом печени в терминальной стадии. Клинические перспективы гастроэнтерологии, гепатологии 2012; 5: 19-26.][2. Власов В.В. Эффективность диагностических исследований. М.: Медицина 1988; 256.][3. Краснов О.А., Павленко В.В., Краснов К.А., Краснов А.О., Пельц В.А., Старцев А.Б., Аминов И.Х., Сохарев А.С., Керопян С.Е. Современные методы оценки функционального резерва печени в резекционной хирургии органа. Медицина и образование в Сибири. 2014; 6, available at: http://www.ngmu.ru/cozo/mos/article/ text_full.php?id=1603].][4. Кучерявый Ю.А., Стукова Н.Ю., Ахтаева М.Л. Хронический гепатит, цирроз печени и гепатоцеллюлярная карцинома - звенья одной цепи. Клинические перспективы гастроэнтерологии и гепатологии 2012; 5: 3-12.][5. Лечение осложнений цирроза печени: методические рекомендации для врачей. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2009; 1 (19): 78-86.][6. Тайшин Д.О., Солдатова Г.С. Анализ прогностических шкал для оценки исхода цирроза печени. Вестник НГУ. Серия: Биология, клиническая медицина 2014; 2 (12): 76-85.][7. Flodén A. Calculation and comparison of the model for end-stage liver disease (MELD) score in patients accepted for liver transplantation in 1999 and 2004. Transplant Proc 2007; 39: 385-386.][8. Huo T.I. The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy. J Clin Gastroenterol 2006; 40 (6): 543-50.][9. Kamath P.S., Wiesner R.H., Malinchoc M. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33 (2): 464-470.][10. Lucey M.R., Brown K.A., Everson G.T. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a natio-nal conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Transplantation 1998; 66 (7): 956-962.][11. Pugh R.N.Н., Murray-Lyon I.M., Danson J.L. Transection of the oesophagus for bleeding oesophageal varices. Brit J Surg 1973; 8 (60); 646-648.][12. Rahimi-Dehkordi N., Nourijelyani K, Nasiri-Tousi M., Ghodssi-Ghassemabadi R., Azmoudeh-Ardalan F., Nedjat S. Model for end stage liver disease (MELD) and Child - Turcotte - Pugh (CTP) Scores: Ability to Predict Mortality and Removal from Liver Transplantation Waiting List due to Poor Medical Conditions. Archives of Iranian Medicine 2014; 2 (17): 118-121.]