BACKGROUND/AIMS: The role of model for end-stage liver disease (MELD) among Indian patients with cirrhosis is uncertain. We studied and compared MELD with Child-Turcotte-Pugh (CTP) and creatinine-modified-CTP (CrCTP) scores for predicting 1-, 3-, and 6-months mortality. METHODS: One-hundred and two patients with cirrhosis were studied. The CrCTP was calculated by adding creatinine score of 0, 2 and 4 with creatinine levels of ≤1.2mg/dL, 1.3-1.8 mg/dL and ≥1.9mg/dL, respectively to CTP score. Survival curves were plotted and receiver operating characteristics (ROC) curves were used to compare the scores. Predictors of mortality were analyzed using Cox proportional hazards model. RESULTS: Scores of CTP, CrCTP, and MELD have excellent diagnostic accuracy for predicting mortality (c-statistics >0.85). The MELD was superior to CTP for predicting 3-months [c-statistic and 95% confidence interval, 0.967 (0.911-0.992) vs 0.884 (0.806-0.939)] and 6-months [0.977 (0.925-0.996) vs 0.908 (0.835-0.956)] mortality (P=0.05), while CrCTP [0.958 (0.899-0.988)] was better than CTP for predicting 3-months mortality (P=0.02). Serum creatinine (hazard ratio 4.43, P<0.0001) is a strong independent predictor of mortality. CONCLUSION: The MELD accurately predicts mortality in cirrhosis and is better than CTP for predicting the short-term and intermediate-term mortality. Adding serum creatinine to CTP though significantly improves its diagnostic accuracy for short-term mortality; however, it remains lower than MELD alone.
BACKGROUND/AIMS: The role of model for end-stage liver disease (MELD) among Indian patients with cirrhosis is uncertain. We studied and compared MELD with Child-Turcotte-Pugh (CTP) and creatinine-modified-CTP (CrCTP) scores for predicting 1-, 3-, and 6-months mortality. METHODS: One-hundred and two patients with cirrhosis were studied. The CrCTP was calculated by adding creatinine score of 0, 2 and 4 with creatinine levels of ≤1.2mg/dL, 1.3-1.8 mg/dL and ≥1.9mg/dL, respectively to CTP score. Survival curves were plotted and receiver operating characteristics (ROC) curves were used to compare the scores. Predictors of mortality were analyzed using Cox proportional hazards model. RESULTS: Scores of CTP, CrCTP, and MELD have excellent diagnostic accuracy for predicting mortality (c-statistics >0.85). The MELD was superior to CTP for predicting 3-months [c-statistic and 95% confidence interval, 0.967 (0.911-0.992) vs 0.884 (0.806-0.939)] and 6-months [0.977 (0.925-0.996) vs 0.908 (0.835-0.956)] mortality (P=0.05), while CrCTP [0.958 (0.899-0.988)] was better than CTP for predicting 3-months mortality (P=0.02). Serum creatinine (hazard ratio 4.43, P<0.0001) is a strong independent predictor of mortality. CONCLUSION: The MELD accurately predicts mortality in cirrhosis and is better than CTP for predicting the short-term and intermediate-term mortality. Adding serum creatinine to CTP though significantly improves its diagnostic accuracy for short-term mortality; however, it remains lower than MELD alone.
Entities:
Keywords:
ALT, alanine aminotransferase; AST, aspartate aminotransferase; AUC, area under the curve; Anti-HCV, antibody against hepatitis C virus; BCS, Budd–Chiari syndrome; CI, confidence interval; CTP, Child–Turcotte–Pugh score; Child–Turcotte–Pugh score; CrCTP, creatinine–modified Child–Turcotte-Pugh score;; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HR, hazard ratio; INR, international normalized ratio; MELD, model for end-stage liver disease; NPV, negative-predictive value; PPV, positive-predictive value; PT, prothrombin time; ROC, receiver operating characteristic; SBP, spontaneous bacterial peritonitis; SD, standard deviation; SE, standard error; TIPSS, transjugular intrahe-patic porto-systemic shunt; cirrhosis; creatinine-modified CTP; model for end-stage liver disease; mortality; outcome measures prognosis
Authors: G Fernández-Esparrach; A Sánchez-Fueyo; P Ginès; J Uriz; L Quintó; P J Ventura; A Cárdenas; M Guevara; P Sort; W Jiménez; R Bataller; V Arroyo; J Rodés Journal: J Hepatol Date: 2001-01 Impact factor: 25.083
Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Peter Ferenci; Alan Lockwood; Kevin Mullen; Ralph Tarter; Karin Weissenborn; Andres T Blei Journal: Hepatology Date: 2002-03 Impact factor: 17.425
Authors: J M Llovet; R Planas; R Morillas; J C Quer; E Cabré; J Boix; P Humbert; M Guilera; E Doménech; X Bertrán Journal: Am J Gastroenterol Date: 1993-03 Impact factor: 10.864
Authors: Adnan Said; John Williams; Jeremy Holden; Patrick Remington; Ronald Gangnon; Alexandru Musat; Michael R Lucey Journal: J Hepatol Date: 2004-06 Impact factor: 25.083
Authors: Mirjana M Radisavljevic; Goran B Bjelakovic; Aleksandar V Nagorni; Miroslav P Stojanovic; Milan D Radojkovicn; Jasna Z Jovic; Aleksandra M Ignjatovic; Misa M Radisavljevic; Maja M Simonovic Journal: Med Princ Pract Date: 2016-09-27 Impact factor: 1.927
Authors: Eleazar Chaib; Marcos Amaku; Francisco A B Coutinho; Luis F Lopez; Marcelo N Burattini; Luiz Ac D'Albuquerque; Eduardo Massad Journal: Theor Biol Med Model Date: 2013-10-20 Impact factor: 2.432