Wednesday, September 24, 2008

Prognosis in cirrhosis and CHF

A couple from the NEJM that will be of interest to the prognosis-completists out there at least:

1)
First is a paper looking at hyponatremia and early mortality (within 90 days) of being listed for a liver transplant. Hyponatremia was associated with increased mortality and the major point of the article is to make an argument that hyponatremia should be added to the MELD score when deciding organ allocation. It's an interesting discussion of hyponatremia and prognosis in liver disease (which is continued in the accompanying editorial) however the data here are not the type you can apply to bedside prognostication (patient X has a Y% 3 month prognosis etc.).

2)
There's also a look at the prognostic importance of defibrillator shocks in patients with CHF who had ICDs placed for primary prevention (ie - patients who had no known history of life-threatening ventricular arrhythmias). Basically: yes shocks do predict a worse prognosis (hazard ratio in the ballpark of ~5 depending on which specific analysis they did), but prognosis remained pretty good across the cohort (1 year survival was ~82% for those patients who received a shock). For those of you who collect prognostic data, the paper has lots more of it, but - like the hyponatremia article above - this is not necessarily information that's helpful to bring to the bedside.

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