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MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study).

Gelu-Simeon M, Bayan T, Ostos M, Boufassa F, Teicher E, Steyaert JM, Bertucci I, Anty R, Pageaux GP, Meyer L, Duclos-Vallée JC, ANRS HC EP 25 PRETHEVIC study gro - Medicine (Baltimore) (2015)

Bottom Line: The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012).MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis.A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population.

View Article: PubMed Central - PubMed

Affiliation: From the AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire (MG-S, MO, ET, J-CD-V); DHU Hepatinov, Villejuif (MG-S, MO, ET, J-CD-V); Inserm, UMR 1018 CESP, Centre de Recherche en Epidémiologie et Santé des Populations (TB, FB, LM); Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre (TB, FB, LM, J-CD-V); École Polytechnique, Laboratoire d'Informatique (LIX), Palaiseau (J-MS); ANRS, Agence Nationale de Recherches sur le Sida et les hépatites virales, Paris (IB); Inserm, UMR 1193, Villejuif (J-CD-V); AP-HP Hôpital de Bicêtre, Service de Médecine Interne, Immunologie Clinique et Maladies Infectieuses, Le Kremlin-Bicêtre (ET); Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Service d'Hépato-gastroentérologie, Nice (RA); Université de Nice-Sophia-Antipolis, Faculté de Médecine (RA); Inserm, Unité 1065, Nice (RA); Centre Hospitalier Régional Universitaire de Montpellier - Hôpital Saint-Eloi, Service d'Hépato-Gastroentérologie et Transplantation (G-PP); Université Montpellier 1, Faculté de Médecine, Montpellier (G-PP); CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Pointe-à-Pitre Cedex, Guadeloupe (MG-S); Institut National de la Santé et de la Recherche Médicale (Inserm), U.1085, Institut de Recherche Santé Environnement and Travail (IRSET), Rennes (MG-S); and AP-HP Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France (LM).

ABSTRACT
To assess prognostic factors for survival and describe Model for End-Stage liver disease (MELD) dynamics in human immunodeficiency virus+/hepatitis C virus+ (HIV+/HCV+) patients after an initial episode of hepatic decompensation.An HIV+/HCV+ cohort of patients experiencing an initial decompensation episode within the year preceding enrollment were followed prospectively. Clinical and biological data were collected every 3 months. Predictors for survival were identified using Kaplan-Meier curves and Cox models. A 2-slope-mixed linear model was used to estimate MELD score changes as a function of survival.Sixty seven patients were included in 32 centers between 2009 and 2012 (72% male; median age: 48 years [interquartile ratio (IQR):45-52], median follow-up: 22.4 months [range: 0.5-65.3]). Overall survival rates were 86%, 78%, and 59% at 6, 12, and 24 months, respectively. Under multivariate analysis, the MELD score at initial decompensation was predictive of survival, adjusted for age, type of decompensation, baseline CD4 counts, and further decompensation during follow-up as a time-dependent variable. The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012). MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis. A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population.

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Evolution of MELD score in line with survival in HIV/HCV-coinfected patients (N = 66) after an initial episode of decompensation. HCV = hepatitis C virus, HIV = human immunodeficiency virus, MELD = Model for End-Stage liver disease.
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Figure 4: Evolution of MELD score in line with survival in HIV/HCV-coinfected patients (N = 66) after an initial episode of decompensation. HCV = hepatitis C virus, HIV = human immunodeficiency virus, MELD = Model for End-Stage liver disease.

Mentions: The kinetics of MELD score after the initial decompensation episode differed significantly between deceased and nondeceased patients (Figure 4). Three different models were tested with a node at 3, 6, or 9 months after the first episode of decompensation. The mean MELD score of patients who remained alive during the study period fell significantly during the first 6 months by −0.49/month, P = 0.016, while they remained stable in deceased patients (+0.06/month, P = 0.755). After 6 months, the mean MELD score increased significantly by +0.32/month (P < 0.0001) in patients who would die during follow-up, while it did not change significantly (+0.05/month, P = 0.171) among those who remained alive during the study period. Both slopes differed significantly in deceased and nondeceased subjects (P = 0.054 and 0.0004, respectively). Treatment with ATV did not influence the MELD kinetics, the slope of MELD score did not differ between patients treated with ATZ and patients not treated by ATV (P = 0.192). We also tested CD4 dynamics during follow-up (a fall below 200 CD4/mm3 as a time-dependent variable) and did not find that this factor exerted any influence.


MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study).

Gelu-Simeon M, Bayan T, Ostos M, Boufassa F, Teicher E, Steyaert JM, Bertucci I, Anty R, Pageaux GP, Meyer L, Duclos-Vallée JC, ANRS HC EP 25 PRETHEVIC study gro - Medicine (Baltimore) (2015)

Evolution of MELD score in line with survival in HIV/HCV-coinfected patients (N = 66) after an initial episode of decompensation. HCV = hepatitis C virus, HIV = human immunodeficiency virus, MELD = Model for End-Stage liver disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554127&req=5

Figure 4: Evolution of MELD score in line with survival in HIV/HCV-coinfected patients (N = 66) after an initial episode of decompensation. HCV = hepatitis C virus, HIV = human immunodeficiency virus, MELD = Model for End-Stage liver disease.
Mentions: The kinetics of MELD score after the initial decompensation episode differed significantly between deceased and nondeceased patients (Figure 4). Three different models were tested with a node at 3, 6, or 9 months after the first episode of decompensation. The mean MELD score of patients who remained alive during the study period fell significantly during the first 6 months by −0.49/month, P = 0.016, while they remained stable in deceased patients (+0.06/month, P = 0.755). After 6 months, the mean MELD score increased significantly by +0.32/month (P < 0.0001) in patients who would die during follow-up, while it did not change significantly (+0.05/month, P = 0.171) among those who remained alive during the study period. Both slopes differed significantly in deceased and nondeceased subjects (P = 0.054 and 0.0004, respectively). Treatment with ATV did not influence the MELD kinetics, the slope of MELD score did not differ between patients treated with ATZ and patients not treated by ATV (P = 0.192). We also tested CD4 dynamics during follow-up (a fall below 200 CD4/mm3 as a time-dependent variable) and did not find that this factor exerted any influence.

Bottom Line: The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012).MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis.A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population.

View Article: PubMed Central - PubMed

Affiliation: From the AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire (MG-S, MO, ET, J-CD-V); DHU Hepatinov, Villejuif (MG-S, MO, ET, J-CD-V); Inserm, UMR 1018 CESP, Centre de Recherche en Epidémiologie et Santé des Populations (TB, FB, LM); Université Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre (TB, FB, LM, J-CD-V); École Polytechnique, Laboratoire d'Informatique (LIX), Palaiseau (J-MS); ANRS, Agence Nationale de Recherches sur le Sida et les hépatites virales, Paris (IB); Inserm, UMR 1193, Villejuif (J-CD-V); AP-HP Hôpital de Bicêtre, Service de Médecine Interne, Immunologie Clinique et Maladies Infectieuses, Le Kremlin-Bicêtre (ET); Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Service d'Hépato-gastroentérologie, Nice (RA); Université de Nice-Sophia-Antipolis, Faculté de Médecine (RA); Inserm, Unité 1065, Nice (RA); Centre Hospitalier Régional Universitaire de Montpellier - Hôpital Saint-Eloi, Service d'Hépato-Gastroentérologie et Transplantation (G-PP); Université Montpellier 1, Faculté de Médecine, Montpellier (G-PP); CHU de Pointe-à-Pitre, Service d'Hépato-Gastro-Entérologie, Pointe-à-Pitre Cedex, Guadeloupe (MG-S); Institut National de la Santé et de la Recherche Médicale (Inserm), U.1085, Institut de Recherche Santé Environnement and Travail (IRSET), Rennes (MG-S); and AP-HP Hôpital Bicêtre, Service de Santé Publique, Le Kremlin-Bicêtre, France (LM).

ABSTRACT
To assess prognostic factors for survival and describe Model for End-Stage liver disease (MELD) dynamics in human immunodeficiency virus+/hepatitis C virus+ (HIV+/HCV+) patients after an initial episode of hepatic decompensation.An HIV+/HCV+ cohort of patients experiencing an initial decompensation episode within the year preceding enrollment were followed prospectively. Clinical and biological data were collected every 3 months. Predictors for survival were identified using Kaplan-Meier curves and Cox models. A 2-slope-mixed linear model was used to estimate MELD score changes as a function of survival.Sixty seven patients were included in 32 centers between 2009 and 2012 (72% male; median age: 48 years [interquartile ratio (IQR):45-52], median follow-up: 22.4 months [range: 0.5-65.3]). Overall survival rates were 86%, 78%, and 59% at 6, 12, and 24 months, respectively. Under multivariate analysis, the MELD score at initial decompensation was predictive of survival, adjusted for age, type of decompensation, baseline CD4 counts, and further decompensation during follow-up as a time-dependent variable. The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012). MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis. A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population.

Show MeSH
Related in: MedlinePlus