Document Detail

An evaluation of the model for end-stage liver disease and serum C-reactive protein as prognostic markers in intestinal failure patients on parenteral nutrition.
MedLine Citation:
PMID:  18941030     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intestinal failure (IF) patients require parenteral nutrition (PN) to avoid malnutrition and death. However, they face complications of recurrent sepsis and liver failure. By the time liver failure is discovered, it is often too late for intervention and prognosis on the waiting list is grim. The Model for End-Stage Liver Disease (MELD) has traditionally been used to predict mortality in patients with liver failure but has never been analyzed in IF patients who are at risk for liver complications. C-reactive protein (CRP) is an acute inflammatory marker that has been shown to reflect disease progression in nonalcoholic steatohepatitis, a disease that in many ways resembles PN-associated liver disease. MELD and CRP are promising clinical markers of disease progression in IF patients on PN. METHODS: The authors performed a retrospective, case-control study to compare levels of MELD and CRP within the entire population of 133 adult patients referred to Northwestern Memorial Hospital for IF from 1999 to 2006. RESULTS: Elevated MELD score is strongly predictive of increased mortality over the subsequent 6 months. Elevated CRP is strongly predictive over a smaller 3-month window. One-year mortality was significantly greater in patients who have either elevated MELD scores or serum CRP levels. CONCLUSIONS: In this study, the authors evaluated for the first time use of MELD and serum CRP as predictive markers of mortality in IF patients. Both seem to be promising clinical tools to identify which patients are at highest risk for complication.
Krishna Putchakayala; Sharon Polensky; Judith Fitzhugh; Valeria Cohran; Alan Buchman; Jonathan Fryer
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2008-10-21
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  33     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2009 Jan-Feb
Date Detail:
Created Date:  2009-01-23     Completed Date:  2009-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  55-61     Citation Subset:  IM    
Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Kovler Organ Transplant Center, Northwestern Memorial Hospital, Chicago, IL, USA.
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MeSH Terms
Biological Markers / blood
C-Reactive Protein / analysis*
Case-Control Studies
Disease Progression
Intestinal Diseases / complications*
Kaplan-Meiers Estimate
Liver Failure / blood*,  etiology,  mortality
Models, Biological*
Parenteral Nutrition / adverse effects*
Retrospective Studies
Sepsis / etiology
Short Bowel Syndrome / blood*,  complications,  therapy
Reg. No./Substance:
0/Biological Markers; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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