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Evaluation of indocyanine green clearance and model for end-stage liver disease for estimation of short-term prognosis in decompensated cirrhosis

Authors

  • Rudolf E. Stauber,

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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  • Doris Wagner,

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
    2. Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
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  • Vanessa Stadlbauer,

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
    2. Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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  • Stefan Palma,

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
    2. Department of Anesthesiology, Medical University of Vienna, Vienna, Austria
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  • Gerald Gurakuqi,

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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  • Daniela Kniepeiss,

    1. Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
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  • Florian Iberer,

    1. Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
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  • Karl-Heinz Smolle,

    1. Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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  • Josef Haas,

    1. Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
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  • Michael Trauner

    1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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Correspondence
Rudolf E. Stauber, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
Tel: +43 316 385 80268
Fax: +43 316 385 2648
e-mail: rudolf.stauber@medunigraz.at

Abstract

Background: Indocyanine green (ICG) clearance has been proposed as a quantitative liver function test several decades ago. Interest in this method has been renewed following the development of finger pulse densitometry for noninvasive estimation of the ICG plasma disappearance rate (PDR). On the other hand, the model for end-stage liver disease (MELD), which is based on routine laboratory parameters, is widely used for estimation of short-term survival in cirrhosis, but its prognostic value in critically ill cirrhotic patients is unclear.

Aims: The aim of the present study was to compare the diagnostic accuracy of ICG PDR vs. MELD for estimation of short-term prognosis in cirrhotic patients.

Methods: Ninety consecutive cirrhotic patients who were admitted for decompensated disease or were being evaluated for liver transplantation were screened. Patients who underwent liver transplantation within the following 90 days and those with hepatocellular carcinoma were excluded. In the remaining 70 patients, routine laboratory parameters and ICG clearance were analysed. Following an injection of ICG 0.25 mg/kg, PDR was measured by finger pulse densitometry. The diagnostic accuracy of ICG PDR and MELD for prediction of 90-day survival was assessed by receiver–operating characteristic (ROC) curve analysis.

Results: ROC curve analysis revealed superior diagnostic accuracy for MELD as compared with ICG PDR in predicting 90-day survival (area under the ROC curve 0.89 vs. 0.71). A MELD cut-off of 22 provided the best discrimination for prediction of 90-day survival.

Conclusions: MELD is superior to ICG PDR for estimation of short-term survival in patients with decompensated cirrhosis.

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