Model for end-stage liver disease (MELD) exception for portal hypertensive gastrointestinal bleeding

摘要: Portal hypertensive bleeding of the gastrointestinal (GI) tract is a complication end-stage liver disease. Bleeding can be controlled endoscopically and pharmacologically in up to 90% patients. 1 Transjugular intrahepatic portal systemic shunt (TIPS), or less often surgery, are alternative treatments for patients with recurrent refractory variceal from gastropathy who have contraindication TIPS bleed despite patent TIPS. The mortality rate close 100%, but these clinical situations difficult quantify purpose organ distribution. may contraindicated number Despite its minimally invasive nature, has been associated 30-day as high 48%. 2 Many authors looked at various factors poor prognosis after TIPS, which include serum bilirubin creatinine levels, Child-Pugh score, encephalopathy. development Model End-Stage Liver Disease (MELD) was based on predicting This system now modified applied distribution United States. 3 ability predict not improved by including GI MELD. 4 Bilirubin shown investigators good predictor Rajan colleagues 5 that an “elevated pre-TIPS