The Relationship between MELD Score, Bilirubin, Albumin, and INR Levels and Prognosis in Patients with Hepatic Encephalopathy in the Emergency Department

Abstract

Aim: This study aimed to evaluate the relationship between prognosis and model for end-stage liver disease (MELD) score, albumin, bilirubin, and international normalized ratio (INR) levels in patients diagnosed with hepatic encephalopathy (HE) based on Child-Pugh staging. Material and Methods: This prospective observational study included a total of 49 patients diagnosed with cirrhosis of the liver who presented to the emergency department due to HE. Clinical findings and laboratory values of the patients were prospectively recorded. Each patient's Child-Pugh score, MELD score, INR, albumin, total and direct bilirubin levels were determined and compared according to the Child-Pugh stage. Results: Of the 49 patients included in the study, 32 (65.3%) were male and 17 (34.7%) were female, and the median age was 57 (range, 46-85) years. Of the patients, 28 (57.1%) were in Child-Pugh stage B, and 21 (42.9%) were in Child-Pugh stage C. The most commonly observed encephalopathy symptoms were ataxia (93.9%, n=46) and amnesia (81.6%, n=40). MELD score, INR, and bilirubin levels were found significantly higher in the Child-Pugh C group compared to the Child-Pugh B group (p<0.001 for all). Albumin levels were found significantly lower in the Child-Pugh C group (p=0.001). Conclusion: In patients diagnosed with HE, higher MELD score, INR, and bilirubin levels, along with lower albumin levels, are significantly associated with a poor prognosis. These biochemical parameters and scoring systems could serve as important prognostic indicators for early risk stratification and management of patients in the emergency department.

Keywords

• Hepatic encephalopathy
• Child-Pugh score
• MELD score
• Emergency department

Acil Serviste Hepatik Ensefalopatili Hastalarda MELD Skoru, Bilirubin, Albümin ve INR Düzeylerinin Prognozla İlişkisi

Abstract

Amaç: Bu çalışmanın amacı, hepatik ensefalopati (HE) tanısı alan hastalarda, prognoz ile son dönem karaciğer hastalığı modeli (model for end-stage liver disease, MELD) skoru, albümin, bilirubin ve uluslararası normalleştirilmiş oran (international normalized ratio, INR) düzeyleri arasındaki ilişkinin Child-Pugh evrelemesine göre değerlendirilmesidir. Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya, HE nedeniyle acil servise başvuran ve karaciğer sirozu tanısı alan toplam 49 hasta dahil edildi. Hastaların klinik bulguları ve laboratuvar değerleri prospektif olarak kaydedildi. Her hastanın Child-Pugh skoru, MELD skoru, INR, albümin, toplam ve direkt bilirubin düzeyleri belirlendi ve Child-Pugh evresine göre karşılaştırıldı. Bulgular: Çalışmaya dahil edilen 49 hastanın 32'si (%65,3) erkek ve 17'si (%34,7) kadın olup ve hastaların ortanca yaşı 57 (aralık, 46-85) yıl idi. Hastalardan 28'i (%57,1) Child-Pugh B evresinde ve 21'i (%42,9) ise Child-Pugh C evresindeydi. En sık gözlenen ensefalopati semptomları ataksi (%93,9; n=46) ve amnezi (%81,6; n=40) idi. MELD skoru, INR ve bilirubin düzeyleri Child-Pugh C grubunda Child-Pugh B grubuna göre anlamlı derecede daha yüksek bulundu (hepsi için p<0,001). Albümin düzeyleri ise Child-Pugh C grubunda anlamlı derecede daha düşük bulundu (p=0,001). Sonuç: HE tanısı alan hastalarda yüksek MELD skoru, INR ve bilirubin düzeyleri ile düşük albümin düzeyleri kötü prognoz ile anlamlı şekilde ilişkilidir. Bu biyokimyasal parametreler ve skorlama sistemleri, acil serviste hastaların erken risk sınıflandırması ve yönetimi açısından önemli prognostik göstergeler olabilir.

Keywords

• Hepatik ensefalopati
• Child-Pugh score
• MELD skoru
• Acil servis

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