Alocação de fígados para transplante em adultos: vantagens e desvantagens do escore MELD

O processo de alocação de enxertos para transplante hepático é muito complexo em razão, principalmente, da discrepância entre o número de candidatos e o de doadores. O Model for End-Stage Liver Disease (MELD) é um escore de gravidade, desenvolvido nos Estados Unidos, que constitui um robusto preditor de sobrevida de pacientes em lista de espera para transplante hepático. Desde 2006, o Brasil adota o escore MELD para ordenar os receptores em uma fila de espera, com a política de atender antes o mais doente. Sua adoção como critério de alocação reduziu o número de óbitos em lista sem comprometer os resultados do transplante. Há situações que não são bem “atendidas” pelo MELD porque, ou a gravidade da situação clínica independe do grau da hepatopatia, ou o risco de permanecer em lista não é a morte, mas sim a doença avançar além de um ponto em que o transplante não possa ser realizado. Nesses casos, considerados “especiais”, os pacientes recebem pontuação diferenciada no escore, com o intuito de transplantá-los em tempo hábil. Há estudos com o objetivo de aperfeiçoar o MELD, mantendo sempre a objetividade e transparência do escore original

Alocação de fígados para transplante em adultos: vantagens e desvantagens do escore MELD

O processo de alocação de enxertos para transplante hepático é muito complexo em razão, principalmente, da discrepância entre o número de candidatos e o de doadores. O Model for End-Stage Liver Disease (MELD) é um escore de gravidade, desenvolvido nos Estados Unidos, que constitui um robusto preditor de sobrevida de pacientes em lista de espera para transplante hepático. Desde 2006, o Brasil adota o escore MELD para ordenar os receptores em uma fila de espera, com a política de atender antes o mais doente. Sua adoção como critério de alocação reduziu o número de óbitos em lista sem comprometer os resultados do transplante. Há situações que não são bem “atendidas” pelo MELD porque, ou a gravidade da situação clínica independe do grau da hepatopatia, ou o risco de permanecer em lista não é a morte, mas sim a doença avançar além de um ponto em que o transplante não possa ser realizado. Nesses casos, considerados “especiais”, os pacientes recebem pontuação diferenciada no escore, com o intuito de transplantá-los em tempo hábil. Há estudos com o objetivo de aperfeiçoar o MELD, mantendo sempre a objetividade e transparência do escore original

Retrospective study of the survival of patients who underwent cardiopulmonary resuscitation in an Intensive Care Unit

Objective - To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors. Methods - A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality. Results - A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors. Conclusion - Prognostic factors supplement the doctor’s decision as to whether or not a patient will benefit from cardiopulmonary resuscitation

Impact of creatinine values on MELD scores in male and female candidates for liver transplantation

Introduction. A systematic bias against women, resulting from the use of creatinine as a measure of renal function, has been identified in Model for End-stage Liver Disease (MELD)-based liver allocation. Correction of this bias by calculation of female creatinine levels using the Modification of Diet in Renal Disease (MDRD) formula has been suggested.Material and methods. A cohort of 639 cirrhotic candidates for first-time liver transplantation was studied. Creatinine levels were corrected for gender using the MDRD formula. The accuracy of MELD, with or without creatinine correction, to predict 3- and 6-month mortality after inclusion in a transplant waiting list was estimated.Results. Women exhibited significantly lower creatinine levels, glomerular filtration rate, and MELD scores than men. After creatinine correction, female MELD scores had a mean increase of 1.1 points. Creatinine correction yielded an increase of 3 points in the MELD score in 15.2% of patients, 2 points in 22.4%, and 1 point in 17.6% of patients. The likelihood of death at 3 and 6 months after enrollment in the transplant waiting list was similar in males and females and the likelihood of receiving a transplant, as assessed by Kaplan-Meier survival curves, was also similar in males and females.Conclusion. The survival or the likelihood of receiving a transplant while on the waiting list were similar in men and women in both pre- and post-MELD eras and creatinine correction did not increase the accuracy of the MELD score in estimating 3- and 6-month mortality in female candidates for liver transplantation

Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation

Retrospective study of the survival of patients who underwent cardiopulmonary resuscitation in an Intensive care unit

Objective - To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors. Methods - A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality. Results - A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors. Conclusion - Prognostic factors supplement the doctor’s decision as to whether or not a patient will benefit from cardiopulmonary resuscitation

Retrospective study of the survival of patients who underwent cardiopulmonary resuscitation in an Intensive Care Unit

Objective - To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors. Methods - A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality. Results - A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors. Conclusion - Prognostic factors supplement the doctor’s decision as to whether or not a patient will benefit from cardiopulmonary resuscitation