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MELDNa vs MELD-Na vs MELD Cirrhosis class A or B/C all 1 except Na?

PART 1  My non medical opinion. Highly technical discussion of MELDNa calculators vs MELD of Na factor.  I kindly suggest that you do not read further especially if you easily get frightened about test results. This is about various ways of MELD scoring including Na factor and where it might apply. It could cause unnecessary fear, be incorrect and/or not apply to your specific situation.

These scores can only be evaluated by a hepatoligist or an gastroenterologist experienced in HCV, hepatology and Cirrhosis. Patients with decompensated cirrhosis (moderate or severe hepatic impairment; CTP class B or C) should be referred to a medical practitioner with expertise in that condition (ideally in a liver transplant center).

(DISCLAIMER) All comments by myself or other members are our own opinions and do not imply professional medical advice. Direct quotes with links provided should be source evaluated.  
My suggested non exclusive criteria include:
1. Professional medical opinion or another non -medical opinion.
2. Is the Professional medical opinion based on 1 or more doctors, the degree of opposing opinions and general consensus.
3. The strength of the supporting facts of the opinion such as case studies, Clinical Trial Phase, Type and numbers          

I respectively ask that before commenting that you read this entire text and links if needed. Familiarize yourself with a limited basic idea of the discussion and not go too far off topic.  

__________________________________________________________________________

Introduction  I created this discussion based on my observation of the MELD-Na calculator when entering my sodium blood serum results after 1 week of treatment.  I guess i have developed a "hobby" of playing with them to see various outcomes suggested.  

Background technical information if needed
_____________________________________________________________________________
http://hepatitisc.uw.edu/browse/all/core-concepts

2.4 Evaluation an d Staging of Liver Fibrosis
2.5 Evaluation and Prognosis of Patients with Cirrhosis
    Importance of Distinguishing Compensated versus Decompensated Cirrhosis:
    Child-Turcotte-Pugh Score (CTP):
    Model for End-stage Liver Disease (MELD) (especially have a layman's understanding)
        History and Background
          Used to predict what patients should be listed and in what order for liver transplant.   The higher the MELD score, the lower the 3-month survival
        Calculation of MELD Score
        Limitations
        Clinical Use
NOTE: Some of the core concepts have been updated at different times and may not reflect the current situation.
__________________________________________________________________________________  

The Meld calculators

The Meld calculators can be varied updated and may have have different additional criteria including Na results and/or other including algorithms.

http://www.mayoclinic.org/medical-professionals/model-end-stage-liver-disease
The Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used as a disease severity index to help prioritize allocation of organs for transplant.

Mayo Clinic researchers published the original MELD model in 2001. Refinements have been developed since then. These models are for use by medical professionals.
The MELD Model
The MELD-Na Model
The MELD Model, UNOS modification
There are more but mainly looking at  MELD vs MELD-Na Model

Another hosted by The Bologna Liver Oncology Group (BLOG) University of Bologna - ITALY in italian but can be google translated but you should be able to guess what input is needed. This auto show the results for different MELD calculators all at once.
http://www.livercancer.eu/calculators.html

NOTE this show two including Na with different results and have been unable to find out much yet about the differences
One other one
http://gihep.com/calculators/hepatology/meld-na/

_______________________________________________________________________________

Discussion with my guesses included and/or lack of specific knowledge unless confirmed by medical source.

1. The basic and updated MELD calculators use  On Dialysis :Yes/No ,  Minimum values must be 1  Creatinine 1.0 or less mg/dL is 1,0  Total Bilirubin :1 or less mg/dL is 1.0  INR 1.0 or less ratio is 1.0  because figures less than 1.0 because the natural logarithm of 1 is 0 and a value less than 1 would yield a negative value.

The INR is the ratio of a patient's prothrombin time to a normal (control) sample, raised to the power of the ISI value for the analytical system used.   No units are used

2. The lowest possible score is 6 usually mean just over 1% chance of dying in the next 3 months. So who does this apply to with HCV?
a) Not to those with confirmed F2\F3 or lower without any reason or test to confirm F4?
b) MELD would apply to F4 Class B or C
c) What about F3/F4 well compensated?  The mildest form of hepatic encephalopathy is difficult to detect clinically.  and Ascites Grade 1: mild, only visible on ultrasound and CT it is possible to miss these.  Either a less recent test, a doctor without the treatment experience/knowledge of cirrhosis/hepatology and/or a patient not mentioning very mild symptoms that seem chronic (don't want to be seen as weak or a complainer) could be reasons.              

3. MELD-Na introduces sodium in the mix  
_______________________________________________________________________    
PART 2 continues in first comment due to text limitation
Best Answer
446474 tn?1446347682
Their seems to be a misunderstanding of what the MELD score is used for. The MELD score (bilirubin, creatinine, INR) (not MELD-Na) is used to assess the need for a liver transplant by UNOS and liver transplant centers. Range is from 6-40. People with the highest MELD scores are closer to death so they receive a transplant before others that are less ill at the transplant center assuming the organ matches the recipient. That is why it is called "It is The Model for End-Stage Liver Disease (MELD score)."

It is only used for people that are cirrhotic with complications arising from their liver disease. It has no meaning for folks with lesser liver disease.

"2. The lowest possible score is 6 usually mean just over 1% chance of dying in the next 3 months. So who does this apply to with HCV? "

"6" has no value for anyone without cirrhosis that has advanced to a certain point. The lowest number the MELD can go to is 6 so all folks without complete cirrhosis (meaning with at least some portal hypertension have normal liver function as shown by normal blood levels so everyone will have a MELD score of 6. So a person with stage 0 liver disease and stage 3 liver disease or even early stage 4 liver disease will all have a MELD score of 6.

Cirrhosis is usually easy to determine. Any good hepatologist or even a good gastro can tell if someone has cirrhosis by performing a simple physical exam. All they need is their hands and a stethoscope.  They can tell the size of both the liver and spleen. They can feel for a hard and nodular liver and enlarged spleen both which are suspicious of cirrhosis. And they can tap to assess if there is any ascites. I've had med students do this and assess my cirrhosis correctly in 2 minutes. Diagnosing cirrhosis is not brain surgery by any means.

Only incomplete cirrhosis (meaning no to little portal hypertension can be harder to determine). But then again it makes little difference any way. What does it matter if someone has early cirrhosis without portal hypertension or with portal hypertension? The person will still be a Childs-Pugh class A. Hepatitis C treatment would be the same either way.

Only when the complications of cirrhosis start to appear (decompensation, Class B cirrhosis) does the nature of the cirrhosis substantially change.

As I said I am not sure what you are trying to determine out but for relevant results you need to use the right tools.

"5. Most suggestions recommend low sodium diet and at least an amount of water to stay well hydrated to prevent a lot of problems during treatment.  

Does anyone have any opinions regarding the inclusion of Na in MELD for F4 Class A and/or consideration if a quite excessive consumption of water such as greater than 4 liters or about 140 oz of water a day during treatment with decreasing sodium below 140 135 etc? "

These factor have no effect on treatment. All that is important is that a person is healthy enough to tolerant treatment. Those with more advanced cirrhosis must be monitored more closely for signs of decompensation or liver failure. Sovaldi has already proven to to safe in patients with compensated cirrhosis.

Cheers
Hector
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Avatar universal
Nan, this combo does give great hope. :)   My ALT/AST #'s have dropped dramatically in the first 25 days.  Almost UND on my viral load (1 over und) My bilirubin and creatinine however haven't changed much.  I have labs drawn Monday so I hope to be UND and see bili, creatinine, and INR all improved.  My platelet #'s are rising and in the normal range.  Hoping to see improvement here as well.   I just wondered if the meds themselves (as ribavirin does) might  affect some lab results in a negative way?  Praying for your husband and for you, and that we all get through this.    :)  Be well.

Jimmy, not to worry, I am under supervision of a great doctors at a teaching hospital....... and Thankful for another day.
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Avatar universal
"Does the Sovaldi/Olysio treatment regimen affect components of the MELD-na score?  i.e. will the meds themselves cause  Bili, Sodium, INR Creatinine to rise or fall...are there things one can do to help improve Creatinine, Bili, INR, results?"

My husband has been on the Sovaldi/Ribavirin treatment for 8 weeks now.
I posted this on another thread. I think it clearly shows that treatment can and does affect the components of the MELD score. How? By eliminating the virus
that is the offending agent to your liver. Once its diminished and finally cleared, your liver has a chance to reapir itself as best it can.

JimmyMose had posted the following:
"AST or ALT tests and are only used to detect inflammation due to injury or damage to the liver from any source."

My response:
I find this very interesting as I was able to take a look back at my husband's ALT/AST numbers since his transplant in June, 2012.  Due to a hepatic artery blockage found one month post tranpslant, he sustained extensive billary tree damage, including inflamed, blocked bile ducts. When bile ducts are blocked, the bile can't flow freely resulting in high billirubin numbers also. He had stents in for a while to keep the bile ducts open  but he became susceptible to bacterial infections so they were removed.  In his highest point in May, 2013, he reached a high of 68 (ALT) and  198 (AST). Billirubin reached a high of 3.3.  This was a very difficult period for him. Hospitalizations almost every month. Things did improve after that.

Fast forward now to 2/12/14 - the day before he started HCV treatment.
ALT (24)  AST (61)  Billirubin (2.2)

NOW   -    8 weeks on Sovaldi/Ribavirin treatment -  4/11/14    
ALT (7)  AST (24)  Billirubin  (1.2)

For me, this is definitive evidence that this treatment by eliminating the virus. It is allowing the liver to heal itself.  The inflammation is being reduced and the bile is getting through.

How could this not give one hope that things will continue to get better?

Nan
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Avatar universal
You really need to ask your doctor if you have any concerns.  Before you make any changes in diet or take supplements herbs that haven't already been recommended by the doc or provided in your treatment guide.

FYI for anyone really
Just checking if you read my introductory comments at the very top? This discussion is not meant to cause concern. It's more of a layman's learning a little more of the process and some of the finer points of the MELD test,.  .
Don't get to concerned about this discussion. Ok if you just want to maybe learn a little more by non-professionals unless referenced  The medical provider is the one who should get concerned if applicable and take action..

Again a good reason to get a highly experienced liver professional like a gastro and/or hepatologist who treats cirrhosis and is knowledgeable in hepatology. Who can evaluate whether you may be progressing to Decompensated Class B C by exams and tests, interpret changes in MELD score that may indicate a serious concern that requires aggressive rapid medical support including transfer to an appropriate medical center if needed.

Those with decompensated Class B C should be seen by very experienced hepatologist at a liver transplant center.
.  
I have secure messaging with my health providers. Gastro and hep tx NP
Important concerns that don't need quick responses go to Gastro. Treatment related concerns or more general questions i may occasionally message hep tx NP like the one above or ask at next appointment.  Of course for sudden serious problems I would call 911 or get a ride to ER depending on the problem.

My Hep treatment provider said to me
I would not worry too much about the Sodium, although changing the value does affect the MELD calculation significantly, (MELD scores are valuable BUT it is a calculation and has to be taken with a grain of "sodium")
Your sodium is still within normal range, and when I looked back over the past 4 years your sodium value has fluctuated between 136 - 143 (all within normal range), it will vary a little during any given time period.

BTW wikipedia needs updating ?? any professionals here who can :-)
http://en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Disease

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Avatar universal
Does the Sovaldi/Olysio treatment regimen affect components of the MELD-na score?  i.e. will the meds themselves cause  Bili, Sodium, INR Creatinine to rise or fall?   Obviously reducing salt intake would reduce sodium levels, are there things one can do to help improve Creatinine, Bili, INR, results?  Or are they mainly a function of liver health and improvement?   Thanks
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Avatar universal
I posted HCH hepatologist  in error - should have said a hepatologist experienced with treating HCV
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Avatar universal
Thanks for your input, Advocate. You have done an excellent job helping to keep your husband at a lower MELD score. He is very blessed to have you at his side.

Unfortunately, my husband has been in both situations - ESLD with higher Meld score  and now again, post transplant with Cirrhosis again and early symptoms of decompensation. That's why the Hep C treatment he is on although very difficult for him because of the increased episodes of HE,  is actually a blessing because the virus is now undetected and his body is attempting to heal itself.

Every person is different and unique and that's why the new guidelines stress that those with symptoms of decompensation be treated and monitored by an experienced HCH hepatologist at a transplant center.

I did find in the new European guidelines the following:

http://files.easl.eu/easl-recommendations-on-treatment-of-hepatitis-c-summary/index.html#p=II

Guidelines and Endpoints of HCV Therapy  (Page 1)

"In patients with cirrhosis, HCV eradication reduces the risk of further decompensation, and will reduce, albeit not abolish the risk of HCC. In these patients surveillance for HCC should be continued".

I think that pretty much answers my question. By staying on treatment and hopefully one day achieving SVR, the likelihood of his decompensating further into edema, ascites, and varices is reduced as is his risk of of getting liver cancer.  

I only pray that his quality of life will also improve as a result of finally getting rid of this insidious monster.

Nan


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Avatar universal
JimmyMose, as Hector said, people don't need to worry about their MELD, until they've progressed to Cirrhosis, and even then it is only of concern when the liver begins to decompensate.  My husband was diagnosed with Cirrhosis due to Hep C in 2010, and his MELD has been low since then.  However, the MELD will fluctuate up or down a bit based on different shifts in his labs, but since his liver is still compensated, the shifts in his labs are thankfully still minor, and his MELD has only fluctuated between 6-8 over these past 4 years.  So, right now, for you, the MELD score is just a number that your hepatologist will calculate every 6-12 months based on your labs, to give an overview of the status of your liver.  You can expect it to remain between 6-8 as long as your liver remains relatively healthy.

Nan, as you've already stated and already know, since your husband's new liver has decompensated due Cirrhosis and Hep C, and he's suffering from so many complications of his advanced Cirrhosis, his MELD will swing higher and lower based on his specific complications, when he has an infection, when his kidneys aren't working well, etc.  You are far more knowledgeable than I am about decompensated Cirrhosis, but as you know, you can expect your hubby's MELD to improve somewhat as he clears his current infection and his kidneys start to heal.  However, of course, since his liver is already decompensated, his MELD will remain somewhat high, just not as high as it is right now.  I know you are already aware of this, but thought I would throw in my inexperienced 2 cents worth about MELDs.  My only first hand experience was with a friend.  When her MELD was around 16, she was able to function somewhat well with careful medical care and treatment of complications and symptoms (ascites, edema, infections, HE).  When her MELD was around 20, she was less able to function even with careful medical care and complications and symptoms (severe ascites, severe edema, loss of mobility, difficulty breathing).  Again, I'm not knowledgeable about decompensated Cirrhosis, but every individual is different, and some with a higher MELD may feel relatively well, and some with a higher MELD may have significant suffering with symptoms and complications.  It seems to be a day by day thing with many variables depending upon the unique configuration of each case.

Advocate1955

Advocate1955
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Avatar universal
Looks like great minds think alike.  :-)  I was posting my last post about the European guidelines at the same time you were posting yours.

My husband is not on a transplant list  but is being treated post transplant by a transplant center in our own state. I don't know what will happen going forward that's why I am wondering if these improvements will hold up after treatment stops.

This mistake happened on the weekend. I brought him in because he had 102 fever which actually resolved by the time he got to the ER. They started him on Vancomycin and did blood cultures. Since one of his bottles was growing something and the other wasn't, they repeated the cultures and kept him on the antibiotic.  They did a vancomycin trough at day 3 and the lab had indicated that the antibiotic should be stopped based on the test results but  the order was not made because a nurse practitioner was making the orders over the weekend (phone consultation only with a doctor I was told).  
Unbelievably, he was given 2 bags he should not have been given and within a day his creatanine spiked. A second trough done came in at 38 and was only read after the 2nd bag of IV antibiotic was given.

Sorry to be going off topic but I think we all have the same concerns and its important that everyone understand how precarious one's health is when you you progress to cirrhosis as a result of this Hep C infection.

Nan

This happened at a top teaching hospital. Proof that this can happen anywhere and that especially on the weekend you need to be extra vigilant.




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Avatar universal
Just found the European Association on Treatment of Hepatitis C 2014

http://www.easl.eu/_newsroom/latest-news/easl-recommendations-on-treatment-of-hepatitis-c-2014#

See page 7 for recommendations for GT2

How long is your treatment for?  These guidelines recommend extended treatment 16-20 weeks for patients with cirrhosis.

I believe your question to Hector:
"In Scenario 2  The doctor didn't order ultrasound within 6 months prior to new treatment SOV/RBV GT2.  What's your opinion? "
indicates your worry that you may have progressed to cirrhosis.

Is that the case?

Nan

PS So sorry to hear you lost 3 friends. I don't blame you one bit for waiting for a non-interferon based treatment.

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Avatar universal
Glad your husband it out of the hospital and hope conditions improve and SVR is achieved.

Have heard they can go up and down. HectorSF can offer a better opinion . Did your husband  experience that while waiting for a transplant?

Hopefully someone reading this discussion will be better motivated to be sure to get a excellent doctor with cirrhosis, liver, HCV, hepatology, experience and/or for decompensated cirrhosis a medical practitioner with expertise in that condition (ideally in a liver transplant center)

The specialist has to evaluate fluctuations in blood scores, imaging information, vitals, personal examination, observation. They need to have good communications with other appropriate specialist for input, condition related treatment and consensus.        .

Patients with post-transplant recurrence of HCV infection should be considered for therapy. Significant fibrosis or portal hypertension one year after transplantation predict rapid disease progression and graft loss, and indicate more urgent antiviral treatment (Recommendation B2)

nan535 did you see my comment Re: EASL recommendations for treatment from UK.

http://www.medhelp.org/posts/Hepatitis-C/EASL-recommendations-for-treatment-from-UK--just-out/show/2146895#post_10226393

Patients with post-transplant recurrence of HCV infection should be considered for therapy. Significant fibrosis or portal hypertension one year after transplantation predict rapid disease progression and graft loss, and indicate more urgent antiviral treatment (Recommendation B2)

Patients with HCV genotype 1, 3, 4, 5 or 6 infection can be treated with daily sofosbuvir (400 mg), and daily daclatasvir (60 mg), 12 to 24 weeks, with or WITHOUT daily weight-based ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg, respectively), pending more data in this population (Recommendation B1)

Daclatasvir should be administered at the dose of 60 mg (one tablet) once per day. It is overall well tolerated. Dose adjustments are not needed in patients with Child B or C disease. The most frequently reported side effects with daclatasvir were fatigue, headache, and nausea.

Not officially approved yet but like here by later this year.
It's been approved for Compassionate-use by a one or more countries already in EU

Now if I could only find "Scotty" to beam you and your husband over to that country.:-)

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Avatar universal
Thank you for your detailed comment "Cheers"

I was pretty certain that MELD didn't apply to pre F0 - F3 and did apply to Class B & C.

Re: Na 142 to 136 within a couple of week I didn't think so to begin with but was just curious. That's why after my Hep NP replied I just commented here  "Obviously I'm not that concerned about it". and didn't reply back to NP.

Further discussion of Cirrhosis Class A
If "Any good hepatologist or even a good gastro can tell if someone has cirrhosis by performing a simple physical exam".

Scenario 1  New patient for this liver specialist and who brought previous records   that were from a CT and liver ultrasound over 2 years old. Recent F3F4 A3 high ALT/AST  platelets 100  other bloods all normal.    

1.The patient didn't mention mild or even mild/medium pains or discomfort.. Observation during examination didn't indicate Grade 1/2 encephalopathy but patient does experience some of the symptoms at times but didn't disclose it.

2. Doctor only noticed slight swelling around the lower leg ankle. No hard and nodular liver and enlarged spleen. maybe slightly larger liver. Tap  assessment of ascites negative.

3. Before the doctor order ultrasound or other tests.

What are the chances that the patient is Class A close to B or just inside the B range?

Trying to get a rough idea of the extent a good hepatologist or even a good gastro could if possible could misdiagnosis a Class A. One that has really progressed into early Class B.  Because of the failure of the patient to provide correct information about symptoms and the lack of recent CT or ultrasound tests within the past 12 to 18 months.  

Only based on this information and the lack of more details what your best guess about the limit of a specialist to correctly diagnose the patient in  scenario 1?    
  
Scenario 2  (me)  Long term patient 15 years who only had one very mild occasional symptoms told to doctor who did physical exam.. My 2000 biopsy Stage 2 Grade 1  

Doctor recommended treatment now and then between 2007 to 2011. Platelets started to move lower 130 to 115   He also stated since I was opposed that there was still a pretty good chance that that I wouldn't progress to liver decompensation within in the next 5 years.

Background for no treatment unlucky personal and only experience with HCV persons in treatment.  
I had 3 friends GT1 go through PEG /RBV  One stopped at 4 weeks and died a year later,  Another didn't get SVR and still suffered more from the treatment and died 3 years later heart attack. At one time one of my best friends treated earlier with 3 shots for 72 weeks early 2000's relapsed after tx. tried again with PEG/RBV a few years later.  He was like a zombie for a couple of days after most shots.  Wife and friends had to babysit him. He was never the same had a lot of pain but still pre-cirrhosis. Died 3 years ago during the night after get pain Rx refill.    

In April 2012 MD mentioned new non INF treatments expected in 2014. He strongly recommend another biopsy to determine whether to most strongly recommend treatment now or better to wait.  June 2012 biopsy Stage 2 Grade 2  He recommended to wait. August 2012 got 4 heart stents prior stress and CT because of chest pain.when using the treadmill at increasing speeds. In and out same day quick recovery and back to moderate work with 20# weight lift limit 2 days after. .  

April 2013 was told that almost all PEG/RBV was stopped for most patients except only those needing treatment now or within a year. FibreTest June 2013 FS F3 FS A3  Current Platelets down to 90 to 100 range , AST low 100 range, ALT high 100 range,  

Started tx April 2 2014
I got in in the second group,of 10 and was told I had the least serious condition of the group and the only the 2nd GT2.          

Doctor didn't think I needed new CT or ultrasound test even thought the previous ones was 2+ years ago but always saw me at least every 6 months with exam including CBC liver test.plus some others. My primary would run them also if it was 3 months+ before the last ones  Doctor plans on a schedule for ultrasound after treatment.

I have heard mentioned about having an ultrasound or other within 6 months prior to treatment.

My doctor is a gastro at the VA and a teacher at one of the bigger and respected state universities. Hepatitis and liver disease isn't all he treats but it is a good portion of his practice including a few research papers and participation in state and other panel groups for HCV..          

In Scenario 2  The doctor didn't order ultrasound within 6 months prior to new treatment SOV/RBV GT2.  What's your opinion?  

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Avatar universal
Interesting discussion.

Since my husband (post-transplant) has been on treatment (Sovaldi/Ribavirin 24 wks) I have seen his labwork improve significantly.

Background:  For those unfamiliar - he has cirrhosis of the new liver (F3+/4 Class B) due to aggressive recurrent Hep C and billary tree damage). He has signs of decompensation including portal hypertension and episodes of hepatic encephalopathy attributed to a rare portosystemic shunt. Long ago I was told by the transplant center that did his transplant (out of state) that he would not be a candidate for re-transplant should his  new liver fail because of the recurrent Hep C.  He is now being cared for now by the transplant center in the state where we live.

Before the start of treatment, I calculated his MELD score at 19. Due to the improvements over the course of the last 8 weeks on treatment, his MELD score had  improved to  13.

He just got out of the hospital yesterday. I now calculate his MELD score at 18. Why?   He was given an IV antibiotic that proved toxic to his kidneys.
Creatanine jumped from the improved 1.46 to 2.9.  Once the antibiotic was stopped things started to improve. He is now at 2.6. Renal doctor says kidneys should rebound with time.

So the question I have (which I'm not exactly sure how formulate) is, how real
are these improvements in the labwork in terms of predicting how much the cirrhotic  patient is actually improving.  Can we trust the improved labwork as a predictor of improving the patient's chances of not having the liver fail?

Hope that makes sense.

Nan
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Avatar universal
Forgot to mention other possible errors

Calculator user error either by entering the numbers incorrectly, using incorrect blood tests and/or values.  Possible webpage error in calculation due to failure to reset or temporary server related errors.  
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Avatar universal
PART 2
4  My situation is a limited not serious example I guess
Fibertest July 2013 FS 3 FA 3  Dr says now  F3/F4 probably F4 Class A,  
June 2012 Biopsy Stage 2 grade 2  
limited prior ULTRASOUND and 3D CT abdominal related  2010 2011  (lack of recent test)
see comment #3 April 11 http://www.medhelp.org/user_journals/show/993621/My-Hepatitis---History---Biopsies---Blood-Test---Other-Conditions-

GT2 Started SOV/RBV 1 week ago. ALT, AST dropped to normal Na dropped from 142 to 136  low sodium diet,  

Message to Hep NP
66 and try to restrict salt use in my food, take Hydrochlorothiazide and drinking a little more water than usual during treatment.
I noticed in the MELD Na calculator
On Dialysis : NO, Creatinine : 1 ,Total Bilirubin: 1, INR :1, Sodium :140 or higher  = Meld Na score *6
Changing just the sodium to 136 results = Meld Na score *9
* Please verify all calculations prior to clinical use.x
Do you think I should ease up on restricting salt use but not using an excessive amount? Other thoughts?

Response
I would not worry too much about the Sodium, although changing the value does affect the MELD calculation significantly, (MELD scores are valuable BUT it is a calculation and has to be taken with a grain of "sodium")
Your sodium is still within normal range, and when I looked back over the past 4 years your sodium value has fluctuated between 136 - 143 (all within normal range), it will vary a little during any given time period.

Obviously I'm not that concerned about it.
__________________________________________________________________________________

5. Most suggestions recommend low sodium diet and at least an amount of water to stay well hydrated to prevent a lot of problems during treatment.  

Does anyone have any opinions regarding the inclusion of Na in MELD for F4 Class A and/or consideration if a quite excessive consumption of water such as greater than 4 liters or about 140 oz of water a day during treatment with decreasing sodium below 140 135 etc?  

6. Playing around trying different numbers INR and Creatine with 1.1  1.2 etc have some what of an effect and hardly any with Total Bilirubin

7. the http://www.livercancer.eu/calculators.html shows both MELDNa and MELD-Na  It appears the MELD-Na calculator is different and shows 6.4 as aposed to 9.8 for my value of 9 with the Mayo MELD-Na calculator.

My opinion Conclusion Part 1
Don't assume much or get worried.  That's a good reason why you need a excellent doctor with cirrhosis, liver, HCV, hepatology, experience and/or for decompensated cirrhosis a medical practitioner with expertise in that condition (ideally in a liver transplant center)   .
  
What are your topic relation non medical opinions?
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