Can the MEGX test and serum bile acids improve the prognostic ability of Child-Pugh's score in liver cirrhosis?
BACKGROUND
Liver transplantation is nowadays the therapeutic option for end-stage liver disease. Correct disease staging is the main step towards improving the timing of listing for liver transplantation so as to avoid premature or late entry. The need for correct prognostic evaluation is due to the limited number of donors and to the increasing number of patients awaiting transplantation. Our aim was to verify whether Child-Pugh's score might be improved by adding the monoethylglycinexylidide (MEGX) formation test and/or serum bile acid determination.


METHODS
We evaluated 182 cirrhotic patients (44 Child-Pugh class A, 97 class B, and 41 class C) of mixed aetiology referring to a tertiary care centre for functional staging of liver disease. These patients were prospectively followed-up for 12-72 months. During this period, 45 patients died, 46 received a transplant, and 91 survived without transplantation. The end-point of analysis was either survival or liver disease-related death at the 6th, 12th, 18th and 24th months of follow-up. The 46 transplanted patients were excluded from the study upon transplantation.


RESULTS
In our study, a cut-off for Child-Pugh's score < 8 confirmed its usefulness, especially in short-term prognostic prediction, while mid- and long-term prediction improved by almost 10% by using the combination of a Child- Pugh's score > 8 and an MEGX value < 15 mg/l. Cox's multi-variate regression analysis indicated that MEGX values either with Child-Pugh's score or with prothrombin activity and ascites were independent prognostic variables.


CONCLUSIONS
Besides confirming that Child-Pugh's score as the basis of prognostic evaluation of cirrhotic patients, these results suggest that the MEGX test might be a complement to the original score when a patient is being evaluated for a liver transplantation programme.
Testa
R
R
Department of Internal Medicine, University of Genoa, Italy.
Valente
U
U
Risso
D
D
Caglieris
S
S
Giannini
E
E
Fasoli
A
A
Botta
F
F
Dardano
G
G
Lantieri
P B
PB
Celle
G
G
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000097:blood*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives*; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
D001647:Bile Acids and Salts; D008012:Lidocaine; C001173:monoethylglycinexylidide