![]() ![]() How do you use the FIB-4 in your own clinical practice?Īs with any biomarker, we are really asking two questions. Lastly, the cut offs for HCV are different than those with NASH or HBV. Because AST is also in the numerator, it may overestimate fibrosis in those with alcohol use. Furthermore, inclusion of age makes it less reliable to use longitudinally. It was developed in a cohort of subjects that did not include the young or very old, so it may not perform as well in those populations given that age is in the numerator. While FIB-4 offers an easy and essentially free assessment of liver fibrosis, it is not without limitations. What pearls, pitfalls and/or tips do you have for users of the FIB-4? Do you know of cases when it has been applied, interpreted, or used inappropriately? Willis Maddrey, while a student at Jefferson Medical College. ![]() My decision to become a hepatologist was also influenced in large part due to my interactions with my chairman of medicine, Dr. I first became interested in liver disease while getting my master’s in biochemistry at the University of Texas, Austin while focusing on intermediary metabolism. High MELD score might be an useful predictor of SBP in cirrhotic patients with ascites.How did you develop a clinical interest in liver disease? Was there a particular clinical experience or patient encounter you had? The cirrhotic patients with complicating ascites with higher MELD score have a greater risk of SBP. Patients with 20-29 had an odds ratio of 7.7 (95% CI 4.17-14.20) for SBP, as compared with patients with MELD < or = 19. Patients with MELD > or = 30 had an odds ratio of 14 (95% CI 5.41-36.20) for SBP, as compared with patients with MELD < or = 19. The mean MELD score for patients with SBP was 23 and for those without was 14 (P 0.05) for SBP, as compared with patients with MELD or = 20 than those with MELD or = 30 were 12.5%, 52.38%, and 66.67% respectively. The clinical characteristics were similar between the patients with and without SBP. SBP developed in 65 (26%) patients during hospitalization. The predictive accuracy in patients with and without SBP was evaluated with receiver operating characteristic (ROC) curve. The incidence rate of SBP was compared in the 4 groups according to the MELD score. The patients were graded with MELD formula into 4 groups (MELD or = 30). The data collected included the age, sex, etiology of liver disease, serum creatinine, total bilirubin, prothrombin time with international normalized ratio and ascitic fluid analysis of the patients. We aimed to investigate the predictive value of model for end-stage liver disease (MELD) score at admission in predicting incidence rate of SBP in cirrhotic patients with ascites, so as to evaluate its use in early diagnosis and prognosis of this complication.Ī retrospective study enrolling 254 consecutive patients with cirrhosis and ascites between June 2003 and June 2006 was carried out. Early identification of high-risk patients is crucial for prognostic improvement. Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. ![]()
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