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Introduction

In cirrhosis, several prognostic scores have been developed to predict overall and complication-free survival. The MELD (Model for End-Stage Liver Disease), MELD-Na and MELD3.0 scores have been proposed as a criteria for allocating organs.

Aims & Methods

The aim of our study was to assess the performance of these 3 scores for the prediction of overall and complication-free survival in decompensated Tunisian cirrhotic patients.
Methods: We conducted an observational, retrospective study involving all patients with decompensated cirrhosis managed in Gastroenterology department of Taher Maamouri hospital during the period from January 2010 to December 2021. Mortality was assessed using the Kaplan Meier model. The performance of the scores was assessed using the AUROC (Area under the Receiver Operating Characteristic curve).

Results

One hundred and fifty-two patients were included with an average age of 61 years. Viral liver cirrhosis was the most common (65.13%). The mean value of the MELD-Na and MELD3.0 scores was 17.74 and 19.4, respectively. The mean follow-up time was 17.1 months. The rate of complications and short-term mortality was 33.6% and 18.4% respectively.
The AUROC of the MELD3.0 score in predicting of the occurrence of further decompensation was the highest (0.775) compared to those of the MELD and MELD-Na score (0.743 and 0.756 respectively). The cut-off value of the MELD3.0 score in predicting further decompensation was 20 (sensitivity 60.7%, specificity 73.3%).
In the prediction of 3-month mortality, the AUROCs of the MELD, MELD-Na and MELD3.0 scores were 0.786; 0.841 and 0.850 respectively. The cut-off value of the MELD3.0 score was 24 (sensitivity 68%, specificity 88%). A statistically significant correlation was noted between the MELD3.0 score ≥24 and 3-month mortality (p=0.04).

Conclusion

The MELD3.0 score had the best predictive value for the occurrence of further decompensation and short-term mortality in decompensated cirrhotic patients. Those with a MELD 3.0 score ≥24 should be prioritized on waiting lists.

MELD 3.0 SCORE IN CIRRHOTIC PATIENTS: PREDICTIVE VALUE OF OVERALL AND COMPLICATION-FREE SURVIVAL

sahar chtioui 1, sahar chtioui 1, sahar chtioui 1, sahar chtioui 1, sahar chtioui 1, sahar chtioui 1, sahar chtioui 1, sahar chtioui 1

1 Taher Maamouri hospital, Nabeul, Tunisia

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Podcast Episode

UEG Podcast

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AI Essentials: Lower GI (UEG Talks rewind)

Louis Liu, Alanna Ebigbo, Pradeep Mundre

Topics

Endoscopy

Published

2025

UEG Podcast Episode

UEG Podcast

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Ten commandments of the colon

Egle Dieninyte - Misiune 1, Cesare Hassan 2

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Humanitas University, Rome, Italy

Topics

Endoscopy

Published

2024

UEG Podcast Episode

UEG Podcast

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UEG Online Courses x UEG Podcast: Impact of polyp detection in colonoscopy

Raf Bisschops, Manuele Furnari, Pieter Sinonquel, Veronique Van der Voort

Topics

Endoscopy

Published

2026

UEG Presentation

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THE IMPACT OF SCREENING COLONOSCOPY KEY PERFORMANCE INDICATORS ON THE RISK OF FUTURE COLORECTAL CANCER AND ADVANCED POLYPS

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Introduction

Polyp detection rates are considered surrogate indicators of colonoscopy quality. Current evidence suggests that improving these in low detectors may reduce the risk of post colonoscopy colorectal cancer (PCCRC). It is unclear whether an upper threshold exists above which this becomes less clinically meaningful. The aim of this study was to assess the impact of KPIs in a high polyp detector group on the future risk of advanced polyps and colorectal cancer diagnoses within 3 years of screening colonoscopy. The PCCRC rate and number of interval cancers and advanced polyps detected were also described.

Aims & Methods

This was a retrospective cohort study of patients undergoing screening colonoscopy. Endpoints of advanced polyps or colorectal cancer and were identified by analysis of routine linked healthcare data through the Secure Anonymised Information Linkage (SAIL) databank. A multivariate cox regression analysis assessed the impact of colonoscopist performance indicators on outcomes of future diagnoses of advanced polyps or colorectal cancer.

Results

5807 patients were included with a median follow-up of 60.1 months. There were 1.5% interval advanced polyps and 0.9% colorectal cancers identified with a median time to diagnosis of 19.8 and 39.2 months respectively. PCCRC rate was 3.8%. The median polyp detection rates were 62.2% with an adenoma detection rate of 50.9% amongst the colonoscopists. There was minimal variation in outcomes of advanced polyp or colorectal cancer diagnoses in these high detectors with no impact demonstrated of higher thresholds of the assessed key performance indicators on this.

Conclusion

It appears a threshold exists above which increasing performance indicators may not translate to better clinical outcomes. This is the first evidence assessing this in a group of high polyp detectors. The thresholds suggested may be utilised in endoscopy training, guiding surveillance recommendations, new technology and screening programmes.

Disclosure

N/A

THE IMPACT OF SCREENING COLONOSCOPY KEY PERFORMANCE INDICATORS ON THE RISK OF FUTURE COLORECTAL CANCER AND ADVANCED POLYPS

Jody Parker 1, Giles Greene 2, Jared Torkington 1, SUNIL DOLWANI 3

1 Cardiff and Vale University Health Board, Cardiff, United Kingdom

2 Welsh Cancer Intelligence and Surveillance Unit, Cardiff, United Kingdom

3 Cardiff University, Cardiff, United Kingdom

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology Endoscopy

Submission format

Abstract

Session

Screening colonoscopy: How to save lives

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Mistakes In Articles

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Upper and lower gastrointestinal endoscopy examinations are performed daily as routine diagnostic procedures in a large number of patients with nonspecific indications, such as heartburn, pain, anaemia, bleeding, workup of portal hypertension and so on. Most of the examinations will point to a classic diagnosis (e.g. peptic disease, cancer, variceal management), but sometimes we see patients who've had multiple diagnostic endoscopic procedures in the previous few months with nonconclusive findings. The diagnostic mistakes discussed here are those that sprang to mind based on our endoscopic experience and they are discussed in an evidence-based approach. For therapeutic endoscopic procedures (e.g. ERCP and resections), we present the most important mistakes that are often seen in our practice and have major consequences for the patient. We propose, from our experience, a simple approach to avoid these mistakes.