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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of different severity scores in correlating hemoglobin levels with the severity of hepatic decompensation: An observational study
Himayat Ullah, Sarwat Huma, Ghulam Yasin, Muhammad Ashraf, Nafisa Tahir, Qazi Tahir Uddin, Hossam Shabana, Mostafa A R Hussein, Abdulrahman Shalaby, Mohammad Mossaad Alsayyad, Ashraf Said, Ali Farahat, Hani Ismail Hamed, Hazem Sayed Ahmed Ayoub, Mohammed S Imam, Essam Elmahdi
Himayat Ullah, Muhammad Ashraf, Hossam Shabana, Department of Medicine, College of Medicine at Shaqra, Shaqra University, Shaqra 15526, Saudi Arabia
Sarwat Huma, Health Professions Education, Health Services Academy, Islamabad 44000, Pakistan
Ghulam Yasin, Department of Orthopedics, College of Medicine at Shaqra, Shaqra University, Shaqra 15526, Saudi Arabia
Nafisa Tahir, Department of Medicine, NUST School of Health Sciences, Islamabad 44000, Pakistan
Qazi Tahir Uddin, Department of Surgery, College of Medicine at Shaqra, Shaqra University, Shaqra 15526, Saudi Arabia
Hossam Shabana, Mostafa A R Hussein, Abdulrahman Shalaby, Ashraf Said, Ali Farahat, Hani Ismail Hamed, Hazem Sayed Ahmed Ayoub, Mohammed S Imam, Faculty of Medicine, Al-Azhar University, Cairo 11865, Egypt
Mohammad Mossaad Alsayyad, Faculty of Medicine for Boys, Al-Azhar University, New Damietta 34517, Egypt
Essam Elmahdi, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
Author contributions: Ullah H, Huma S, and Tahir N were responsible for conceptualization, and data collection; Ullah H, Huma S, Yasin G, and Ashraf M were responsible for writing of the initial draft; Ullah H, Tahir Uddin Q, Shabana H, Hussein MAR, Shalaby A, Mossaad Alsayyad M, Said A, Farahat A, Hamed HI, Ayoub HSA, Imam MS, and Elmahdi E were responsible for writing, editing, and revision of drafts; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: Approved by the Institutional Review Board of Hayatabad Medical Complex, Peshawar, No. 597/HEC/BPSC/2021, dated February 2, 2022.
Informed consent statement: Written Informed consent was taken from all the participants.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Data sharing statement: This will be provided on the authorized request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sarwat Huma, Doctor, MBBS, Academic Fellow, Research Fellow, Health Professions Education, Health Services Academy, Health Services Academy Park Road, Chak Shahzad, Islamabad 44000, Pakistan.
sarwathuma007@gmail.com
Received: September 9, 2024
Revised: October 27, 2024
Accepted: November 20, 2024
Published online: January 27, 2025
Processing time: 120 Days and 14.9 Hours
BACKGROUND
Chronic liver disease is a growing global health problem, leading to hepatic decompensation characterized by an array of clinical and biochemical complications. Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score, model of end-stage liver disease (MELD) score, and MELD-Na score. Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes. Although studies have explored anemia in liver disease, few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.
AIM
To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh, MELD, and MELD-Na scores.
METHODS
This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study. Data was collected on demographics, clinical history, and laboratory findings, including hemoglobin levels, bilirubin, albumin, prothrombin time (international normalized ratio), sodium, and creatinine. The Child-Pugh, MELD, and MELD-Na scores were calculated. Statistical analysis was performed using Statistical Package for the Social Sciences version 26, and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.
RESULTS
The study included 405 males (62.1%) and 247 females (37.9%) with an average age of 58.8 years. Significant inverse correlations were found between hemoglobin levels and Child-Pugh, MELD, and MELD-Na scores (P < 0.01), with the MELD scoring system being the strongest correlator among all. One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system (P = 0.001). Tukey's post hoc analysis confirmed significant internal differences among each severity group.
CONCLUSION
Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.
Core Tip: This study investigates the correlation between hemoglobin levels and disease severity in patients with decompensated liver disease. A cohort of 652 patients was assessed using Child-Pugh, model of end-stage liver disease (MELD), and MELD-Na scores to measure disease severity and its association with hemoglobin levels. The analysis revealed a strong inverse correlation, with lower hemoglobin levels associated with higher disease severity. Among the scoring systems, MELD and MELD-Na showed the most significant associations. These findings suggest that hemoglobin levels could serve as a valuable marker in assessing disease progression, potentially improving clinical management for patients with decompensated liver disease.
