Prognostic Importance of Combined Use of MELD Scores and SII in Hepatic Visceral Crisis in Patients with Solid Tumours.

Abstract

Objective: To determine the sensitivity of combining the model for end-stage liver disease (MELD) scoring with new inflammatory indexes in determining the priority for liver transplantation and demonstrating its potential usability in solid tumour visceral crisis.

Study design: Descriptive study. Place and Duration of the Study: Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkiye, from June 2017 to June 2022.

Methodology:  Patients hospitalised in the medical oncology clinic for hepatic dysfunction were included. The MELD scores of these patients were calculated, and the predictive contribution of the systemic immune-inflammatory index (SII) to prognosis and mortality was evaluated.

Results: A total of 295 patients (158 (53.6%) men and 137 (46.4%) women) were included. When compared for primary tumour types, colorectal cancers were the most common with 55 (18.6%) cases, followed by breast cancers at 52 (17.6%), pancreatic carcinoma at 50 (16.9%), and stomach cancers at 40 (13.6%) cases. In the survival analyses of all three MELD scores (MELD-Original, MELD-Na, and MELD 3.0) between <20 groups and ≥20 groups, the median Overall Survival (OS) for MELD-Original was 1.44 vs. 0.88 months (p<0.001), for MELD- Na it was 1.64 vs. 0.85 months (p<0.001), and for MELD 3.0 it was 2.16 vs. 1.28 months (p=0.039). In the ROC analysis, the SII parameter cut-off was ≥626.28 for the estimation of mortality, SII sensitivity was 78.7%, and specificity was 100% (p=0.013).

Conclusion: Combined use of MELD and SII scores in patients with solid tumours with hepatic visceral crises will be practical, cost-effective, and easy to access, eliminate gender-based disparities, and contribute to clinical follow-ups with objective data.

Key words: Malignant neoplasm, MELD score, MELD-Na, MELD 3.0, SII.