meld score question

[rexx73]

hello,

as i dont know if iam cirrothic i ve gone to a meld score calculator and he says i have 8 points.
with my lab results before 3 months i have only 4 points.
does the therapy affect the inr bili und krea lab results?
if not does that mean iam cirrothic sure or do i have make the meld score with my lab results BEFORE therapy startet?

[HectorSF]

Good luck! ;-)

Hector

[rexx73]

Thanks a lot for you effort you put on this.I will try to follow your tips.

[HectorSF]

As Advocate says, blood levels are constantly changing. Just like everything else in the universe. Nothing is static. "No man ever steps in the same river twice". This as a basic law of nature.

It's the norm that is important. Within the norm is where most healthy people blood values are. 0.7 to 1.3 mg/dL for men is the normal range.
Everything has a range not one number. Makes no difference if mine is 0.8 or 1.2 it is within normal range. I get blood tests at least once every three months. It is very rare if I get the same reading ever. It that a problem? No. It shows that I am alive.
Here are my creatinine levels in mg/dL over the last year.
1.06
0.87
1.23
0.65
0.70
1.00
0.74

To be thinking and worrying about blood creatinine levels that are "normal" is absolutely pointless. Let your doctor worry about your tests that are abnormal. You can help yourself by focusing on your treatment.

Hector

[Advocate1955]

I don't know the specifics about creatinine, but I know that various things can go up and down while you're on treatment.  For example, last year when my husband was on treatment #2 (daily infergen injections and 1400 mg. of ribavirin), his blood sugar increased to diabetes, and his triglycerides increased significantly (doubled I think).  Of course, his hgb, his hematocrit and his WBC all dropped.  His doctors frequently did cbcs to check everything.  Trust your doctor, let him check your lab results and advise you, and just rejoice in your UND at 4 weeks result!  :)
Advocate1955

[rexx73]

Thanks again for reply.
my doctor isn't worry about my lab results,its just me ,as always.
the creatinin is still in the norm I just wondered why it has gone up.

[HectorSF]

"so is it possible to have meld scores above 8 without having cirrhosis?"
Yes. As I said in my previous post, only a doctor can diagnosis cirrhosis.

"when I take my creatinin value 3 months ago I have a meld score 4 ,but with my lab results from last week I have 8.that's why I'm thinking if treatment van cause higher crea levels."

If the treatment or anything else is causing higher creatinine levels...is your doctor worried about it? What does he say about it?

Creatinine measures renal/kidney function NOT liver function. So if someone has kidney disease, they will have an elevated creatinine level. Higher than normal level are seen in patients with high blood pressure and diabetes. Even people that eat a lot meat can have higher than normal levels.
The reason creatinine is used as part of the MELD score (remember the MELD score is used to estimate the chances of death within a 3 month period) is when a End-Stage Liver Disease patient's liver is failing, the kidney's function also begins to fail. Kidney failure is one of many life-threatening complication of liver failure and sometimes requires the addition of a kidney transplant in addition to the liver.

So you see there is only an indirect association between creatinine level and liver function.

Since you have no signs of cirrhosis (your doctor's opinion from your old posts), worrying about liver failure is a mute point. Even if you had cirrhosis. It is not the end of the world. (If it was, myself and a number of others on the forum wouldn't be here).
I have cirrhosis, End-stage Liver Disease and liver cancer (HCC). Can I change that fact? No. Like all challenges in life, we try to face the reality of our situation, assess our best options even when all options aren't good and then decide what we are going to do about it. There is the human "will to live" despite the odds. Every people that has accomplished anything in life has defied the odds. Did Steve Job says 'Oh I have liver cancer now, along with pancreatic cancer. I give up'. No, he did what he had to do and had a liver transplant and lived another 7 years with his wife and kids, helped to get more organ donors here in California and launched the iPhone and iPad before he died.
From my point of view if I were you I would be happy to have found out that you have hepatitis C while you can still treat and cure it. As we all know, the chances of cure for the common HCV genotypes is almost 80%. From where I am standing 80% looks like a miracle. Each of us has the option to look at the 80% or dwell on the 20%. Both are true. But looking at the 80% and new and better treatments in the future, is going to make your a happier person then the one that obsesses over the 20% and all of worse case scenarios.

Good luck with your treatment.
Hector

[Advocate1955]

Thanks for the additional info.  If you are working with a hepatologist and a doctor at a transplant center, then you are probably in excellent hands.  It sounds like you were and are, at least as up to 2010, f3.  My husband had a liver biopsy in 2007 and he was between f1-2 and had a failed treatment.  He had a second liver biopsy in 2010 and he was beginning cirrhosis f4 and did another failed treatment.  Before he started triple therapy on Sep 30, 2011, we asked if he would need another liver biopsy, and his hepatologist said no because we already know that he has cirrhosis so time to move forward with triple therapy.  I got the impression that knowing how much his cirrhosis may or may not have progressed in one year wouldn't be relevant to his triple therapy since we know that according to the trial results he will have about a 59% chance of SVR, we know that he needs to treat for 48 weeks, and we know his liver is still compensated so that he can do the treatment.  However, in your case, it seems as though knowing if you had progressed from f3 to f4 before starting therapy would have provided some additional information about your chances of SVR and how long you need to be on triple therapy (24 or 48 weeks).  Anyway, you are on triple therapy now, and at your last biopsy you were f3, so hopefully your triple with Inc. will clear your virus and hopefully it will stay away!  
When did you start triple therapy and what have your Viral Loads been since you started therapy?
It won't do you any good to worry now about whether you're f3 or f4.  Just focus on the good thing that you're doing for your liver right now:  treating!
Advocate1955

[rexx73]

since 2008 i did not have another biopsy,because my doc sees no need to do another one.he says we know youre sure f3 now lets do the treatment and look what happen.he is a hepatologist.
my other doc is working at a transplant center and he cant say also im cirrhotic or not.
i had a fibroscan done the last 3 years.2009 the scan said 70 kpas but the doc said this was due the wrong placement from the operator.
2010 the fibroscan sais 9 kpas wich he said would be f3.
last year the scan showed 30 kpas.
my doc said that a fibroscan is not accurate in my case as iam very thin.

[Advocate1955]

Have you had another liver biopsy since 2008?  If so, what were the results?  Is your doctor a hepatologist?
Advocate1955

[rexx73]

yes im from Europe Switzerland,currently on triple treatment with inc.
my main problem is that since summer I feel bad and nobody can tell me why.I did a gastrocospy many blood work but they can't find the reason for why I feel so crappy all the time.
sometimes I think they know why but won't tell me
I felt crappy already before I started treatment

[Advocate1955]

From reading your profile, it appears that you are in Switzerland, have genotype 1, and were f3 based on liver biopsy results 3 years ago.  It also sounds like you are currently on treatment, but I can't see what treatment you are on (SOC?  Triple therapy?).  As others said above, ask your doctor if you have cirrhosis (f4).  Let us know some additional information.  From your other posts, it sounds like 1) you're worried as to whether or not you have progressed from f3 to cirrhosis, and 2) you're worried about how your liver disease will progress and what the future holds.  These are questions your doctor can answer for you based on your specific case, but we hope to hear back from you with more information.  Best wishes.
Advocate1955

[copyman]

hector answered your question. you can not use meld score without a diagnosis of cirrhosis. You need results from a biopsy, etc
best of luck

[rexx73]

so is it possible to have meld scores above 8 without having cirrhosis?
when I take my creatinin value 3 months ago I have a meld score 4 ,but with my lab results from last week I have 8.that's why I'm thinking if treatment van cause higher crea levels.

[HectorSF]

Ask you doctor if you have stage 4, cirrhosis. This is something that everyone with hepatitis C needs to know before starting hep C therapy as it has a profound affect on treatment.

As can-do said the MELD score scale ranges from 6 to 40. It is NOT used to diagnose cirrhosis. A biopsy or a noninvasive assessment of liver fibrosis such as FibroSure/FibroTest, FibroScan or Hepascore depending on your country is used to assess the degree of liver fibrosis.

The MELD score is a tool used by the transplant community to predict mortality over a 3 month time period. It is used to give a quantifiable number so that patients illness can be compared, so that the person with the least time to live (the sickest who will be able to survive the transplant surgery) will get a transplant before others less sick.

In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:

    40 or more — 71.3% mortality
    30–39 — 52.6% mortality
    20–29 — 19.6% mortality
    10–19 — 6.0% mortality
    <9 — 1.9% mortality

Plugging in bilirubin and creatinine numbers has no meaning without a diagnosis of cirrhosis and compromised liver function. There are many other conditions and illnesses that can cause abnormal bilirubin and creatinine levels besides cirrhosis.

You need to find out if you are cirrhotic BEFORE starting therapy.
* It will determine your chances of SVR.
* Length of treatment if you are genotype 1
* The complications and side effects that may become problematic and could cause you to have to stop therapy. For example if you don't have a high enough platelet count before starting treatment.
* The risk of liver decompensation or liver failure when on hep C therapy
* If you have cirrhosis it could affect your chances of waiting for future treatment if the time the treatment doesn't work of if you have to stop treatment due to side effect of interferon.

So talk to your doctor who will be treating your hep C. Find out the current stage of fibrosis, if any, your liver has. Then when you start treatment you will know your baseline condition.

Good luck with treatment.
Hector

[can-do-man]

Its been my understanding the meld range is from 6 to 40. Not sure how you came up with a 4.......... Anyway an 8 is nothing to worry about