RESUMEN
OBJECTIVE: This study aimed to evaluate the impact of the combined Albumin-bilirubin (ALBI)/sarcopenia score as a newly developed prognostic model for hepatocellular carcinoma (HCC), with a focus on its utility in predicting mortality. METHODS: This prospective study was conducted on HCC patients who were followed for 1 year or until death. Sarcopenia was assessed radiologically by computed tomography at the level of L3. The study consisted of two sets: a development set in which the new ALBI-sarcopenia score was created, comprising 262 HCC patients, followed by an internal validation set with 100 patients. RESULTS: The development cohort primarily included males (69.5%), aged 59.6 ± 8.09 years. In patients with sarcopenia, the ALBI score was -2.03 ± 0.42 ( P < 0.006), the model for end-stage liver disease (MELD) score was 11.29 ± 2.43 ( P < 0.001*), and the MELD-sarcopenia score was 21.29 ± 2.43 ( P < 0.001*). The distribution of barcelona clinic liver cancer (BCLC) staging was as follows: BCLC A 18 (15.9%), BCLC B 63 (55.8%) and BCLC C 32 (28.3%) ( P < 0.001*), with a notable association with higher mortality ( P < 0.001). Multivariate analysis identified sarcopenia and ALBI scores as independent predictors of mortality in HCC ( P < 0.001*). In the development set, the ALBI-sarcopenia score successfully predicted mortality at a cutoff >-11 with an area under a curve of 0.837 (95% CI, 0.784-0.889), while in the validation set, it predicted mortality at a cutoff >-11.55 with an area under a curve of 0.842 (95% CI, 0.753-0.930). CONCLUSION: The newly introduced ALBI-sarcopenia score has demonstrated superior effectiveness in comparison to MELD-sarcopenia score, overcoming the shortcomings associated MELD score in forecasting outcomes for patients with HCC.
Asunto(s)
Bilirrubina , Carcinoma Hepatocelular , Neoplasias Hepáticas , Sarcopenia , Humanos , Masculino , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/sangre , Carcinoma Hepatocelular/diagnóstico , Sarcopenia/diagnóstico , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/sangre , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Bilirrubina/sangre , Anciano , Pronóstico , Tomografía Computarizada por Rayos X , Valor Predictivo de las Pruebas , Albúmina Sérica/análisis , Albúmina Sérica/metabolismo , Reproducibilidad de los Resultados , Estadificación de Neoplasias , Factores de Riesgo , Albúmina Sérica Humana/análisis , Técnicas de Apoyo para la Decisión , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Vasodilatation and bacterial dislocation are the main contributors to the catastrophic events in patients with decompensated liver cirrhosis (DLC). AIM: The aim of this study was to evaluate the impacts of adding midodrine and rifaximin on morbidity, mortality, and quality of life in patients with DLC. METHODS: This interventional clinical study included 100 consecutively enrolled DLC patients randomized 1â :â 1 into two groups. Group A received oral midodrine (5â mg/8â h) and rifaximin (550â mg/12â h) with standard diuretic therapy, while group B received only standard diuretic therapy. Clinical and laboratory data, including the McGill Quality of Life Questionnaire, were evaluated over a 3-month treatment period. RESULTS: In the study group, there was a significant reduction in Child-Pugh and Model for End-Stage Liver Disease scores, international normalized ratio, and mean arterial blood pressure at 2, 6, and 12 weeks (Pâ <â 0.05). Ascites, spontaneous bacterial peritonitis incidence, hematemesis, paracentesis need, and hepatic encephalopathy showed improvement after 12 weeks compared with the control group. McGill Quality of Life Questionnaire significantly improved after 6 and 12 weeks (Pâ <â 0.05). Survival rates demonstrated a noteworthy improvement (Pâ =â 0.014), substantiated by evidence in both univariate and multivariate regression analyses. CONCLUSION: Combined midodrine with rifaximin represents an endowment to patients with DLC with spectacular improvements in synthetic liver functions, along with improved quality of life, and survival.