Original article—liver, pancreas, and biliary tract
Model for End-Stage Liver Disease Score Predicts Outcome in Cirrhotic Patients During Pregnancy

https://doi.org/10.1016/j.cgh.2011.03.036Get rights and content

Background & Aims

Pregnancy is rare among patients with cirrhosis, and data about complications and outcomes are sparse. We evaluated the utility of prognostic models of severity of cirrhosis in determining outcomes in pregnant women with cirrhosis.

Methods

We evaluated all cirrhotic patients who self-reported pregnancy at our center and correlated prognostic scores at the time of conception with outcomes.

Results

Sixty-two pregnancies occurred in 29 women. The median model for end-stage liver disease (MELD) score at conception was 7 (range, 6–17), the median MELD sodium score was 9 (range, 6–17), the median United Kingdom end-stage liver disease (UKELD) score was 44 (range, 36–53), and the median Child–Pugh score was 5 (range, 5–8). The live birth rate was 58%; the median gestational age was 36 weeks. Higher MELD (P = .01), MELD sodium (P = .01), UKELD (P = .01), and Child–Pugh (P = .03) scores were associated with gestation <37 weeks. Maternal complications (ascites, encephalopathy, or variceal hemorrhage) occurred in 10% of patients and were associated with higher MELD (P = .01) and UKELD (P = .02) scores. Receiver operator curve analysis demonstrated that a MELD score ≥10 predicted, with 83% sensitivity and 83% specificity, which patients were likely to have significant, liver-related complications (area under curve, 0.8); a UKELD score ≥47 had 83% sensitivity and 79% specificity (area under curve, 0.8). No patient who had a MELD score ≤6 or a UKELD score ≤42 developed any significant hepatologic complications.

Conclusions

MELD and UKELD scores at the time of conception can be used to predict specific clinical outcomes in pregnant women with cirrhosis.

Section snippets

Patients and Methods

We reviewed all cirrhotic patients who reported pregnancy at our institution between 1984 and 2009. Patients were identified from a prospectively collated liver database using the search terms pregnancy, cirrhosis, abortion, miscarriage, and termination. The clinical records were reviewed in all patients and data extracted in a standard fashion. The diagnosis of cirrhosis was made histologically or using a combination of radiological and laboratory investigations in cases where a biopsy was not

Results

There were 62 pregnancies in 29 cirrhotic women, where all clinical information was available to calculate prognostic scores. Scores were calculated from clinical information at the clinic visit immediately prior to pregnancy being reported (median 3 months from conception [range, 1–6 months]). Cirrhosis was diagnosed on liver biopsy in 41/62 (66%) and by radiological and laboratory parameters in 21/62 (34%). The underlying diagnosis was autoimmune (n = 27), alcohol-related (n = 10), viral (n =

Discussion

In this study, we have identified that pregnancy in patients with cirrhosis carries a high incidence of maternal morbidity, occurring in 10% of pregnancies. A live birth rate of 58% is observed with 75% of neonates born prematurely and 17% of live births requiring neonatal intensive care unit. We have demonstrated that the prognostic scoring systems of MELD, MELD-Na, UKELD, and CP scores at the time of conception can be used to predict certain outcomes and complications that may be encountered

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  • Cited by (0)

    This article has an accompanying continuing medical education activity on page e84. Learning Objectives—At the end of this activity, the learner should distinguish models that are prognostic for outcomes in pregnant women with cirrhosis.

    Conflicts of interest The authors disclose no conflicts.

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