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Journal of Clinical and Experimental Hepatology logoLink to Journal of Clinical and Experimental Hepatology
. 2012 Jan 2;1(3):161–168. doi: 10.1016/S0973-6883(11)60233-8

Predicting Mortality Across a Broad Spectrum of Liver Disease—An Assessment of Model for End-Stage Liver Disease (MELD), Child–Turcotte–Pugh (CTP), and Creatinine-Modified CTP Scores

Yogesh K Chawla 1,*, Ramesh Chillal Kashinath 1, Ajay Duseja 1, Radha K Dhiman 1
PMCID: PMC3940129  PMID: 25755381

Abstract

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.

Keywords: Child–Turcotte–Pugh score, cirrhosis, creatinine-modified CTP, model for end-stage liver disease, mortality, outcome measures prognosis

Abbreviations: ALT, alanine aminotransferase; Anti-HCV, antibody against hepatitis C virus; AST, aspartate aminotransferase; AUC, area under the curve; BCS, Budd–Chiari syndrome; CI, confidence interval; CrCTP, creatinine–modified Child–Turcotte-Pugh score;; CTP, Child–Turcotte–Pugh score; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; 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

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References

  • 1.Freeman RB, Jr, Wiesner RH, Harper A. UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8:851–858. doi: 10.1053/jlts.2002.35927. [DOI] [PubMed] [Google Scholar]
  • 2.Wiesner RH, McDiarmid SV, Kamath PS. MELD and PELD: application of survival models to liver allocation. Liver Transpl. 2001;7:567–580. doi: 10.1053/jlts.2001.25879. [DOI] [PubMed] [Google Scholar]
  • 3.Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, Ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–871. doi: 10.1053/he.2000.5852. [DOI] [PubMed] [Google Scholar]
  • 4.Salerno F, Merli M, Cazzaniga M. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36:494–500. doi: 10.1016/s0168-8278(01)00309-9. [DOI] [PubMed] [Google Scholar]
  • 5.Kamath PS, Wiesner RH, Malinchoc M. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470. doi: 10.1053/jhep.2001.22172. [DOI] [PubMed] [Google Scholar]
  • 6.Said A, Williams J, Holden J. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol. 2004;40:897–903. doi: 10.1016/j.jhep.2004.02.010. [DOI] [PubMed] [Google Scholar]
  • 7.Botta F, Giannini E, Romagnoli P. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gui. 2003;52:134–139. doi: 10.1136/gut.52.1.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Giannini E, Botta F, Fumagalli A. Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients? Liver Int. 2004;24:465–470. doi: 10.1111/j.1478-3231.2004.0949.x. [DOI] [PubMed] [Google Scholar]
  • 9.Papatheodoridis GV, Cholongitas E, Dimitriadou E, Touloumi G, Sevastianos V, Archimandritis AJ. MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis. World J Gastroenterol. 2005;11:3099–3104. doi: 10.3748/wjg.v11.i20.3099. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Schepke M, Roth F, Fimmers R. Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting. Am J Gastroenterol. 2003;98:1167–1174. doi: 10.1111/j.1572-0241.2003.07515.x. [DOI] [PubMed] [Google Scholar]
  • 11.Giannini E, Botta F, Testa R. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology. 2003;125:993–994. doi: 10.1016/s0016-5085(03)01147-8. [DOI] [PubMed] [Google Scholar]
  • 12.Angermayr B, Cejna M, Karnel F. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut. 2003;52:879–885. doi: 10.1136/gut.52.6.879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Mishra P, Desai N, Alexander J, Singh DP, Sawant P. Applicability of MELD as a short-term prognostic indicator in patients with chronic liver disease: an Indian experience. J Gastroenterol Hepatol. 2007;22:1232–1235. doi: 10.1111/j.1440-1746.2007.04903.x. [DOI] [PubMed] [Google Scholar]
  • 14.Shaikh S, Ghani H, Memon S, Baloch GH, Jaffery M, Shaikh K. MELD era: is this time to replace the original Child-Pugh score in patients with decompensated cirrhosis of liver. J Coll Physicians Surg Pak. 2010;20:432–435. [PubMed] [Google Scholar]
  • 15.Abouassi SG, Mihas A, Williams LM. MELD and CTP scores are equivalent predictors of mortality in cirrhotic veterans referred for orthotopic liver transplantation (OLT) Hepatology. 2001;34:207A. [Google Scholar]
  • 16.Sheth M, Riggs M, Patel T. Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis. BMC Gastroenterol. 2002;2:2. doi: 10.1186/1471-230X-2-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Liado L, Figueras J, Memba R. Is MELD really the definitive score for liver allocation? Liver Transpl. 2002;8:795–798. doi: 10.1053/jlts.2002.34637. [DOI] [PubMed] [Google Scholar]
  • 18.Forman LM, Lucey MR. Predicting the prognosis of chronic liver disease: an evolution from child to MELD. Mayo End-stage Liver Disease. Hepatology. 2001;33:473–475. doi: 10.1053/jhep.2001.22481. [DOI] [PubMed] [Google Scholar]
  • 19.Pagliaro L. MELD: the end of Child-Pugh classification? J Hepatol. 2002;36:141–142. doi: 10.1016/s0168-8278(01)00302-6. [DOI] [PubMed] [Google Scholar]
  • 20.Christensen E, Krintel JJ, Hansen SM, Johansen JK, Juhl E. Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognostic factors. Scand J Gastroenterol. 1989;24:999–1006. doi: 10.3109/00365528909089247. [DOI] [PubMed] [Google Scholar]
  • 21.Llovet JM, Planas R, Morillas R. Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study. Am J Gastroenterol. 1993;88:388–392. [PubMed] [Google Scholar]
  • 22.Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P. A prognostic model for predicting survival in cirrhosis with ascites. J Hepatol. 2001;34:46–52. doi: 10.1016/s0168-8278(00)00011-8. [DOI] [PubMed] [Google Scholar]
  • 23.Prasad S, Dhiman RK, Duseja A, Chawla Y, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life in cirrhotic patients with minimal hepatic encephalopathy. Hepatology. 2007;45:549–559. doi: 10.1002/hep.21533. [DOI] [PubMed] [Google Scholar]
  • 24.Dhiman RK, Kurmi R, Thumburu KK. Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci. 2010;55:2381–2390. doi: 10.1007/s10620-010-1249-7. [DOI] [PubMed] [Google Scholar]
  • 25.Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–721. doi: 10.1053/jhep.2002.31250. [DOI] [PubMed] [Google Scholar]
  • 26.Dhiman RK, Makharia GK, Jain S, Chawla Y. Ascites and spontaneous bacterial peritonitis in fulminant hepatic failure. Am J Gastroenterol. 2000;95:233–238. doi: 10.1111/j.1572-0241.2000.01691.x. [DOI] [PubMed] [Google Scholar]
  • 27.Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  • 28.Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–843. doi: 10.1148/radiology.148.3.6878708. [DOI] [PubMed] [Google Scholar]
  • 29.Guo Z, He X, Wu L. Model for end-stage liver disease versus the Child-Pugh score in predicting the post-transplant 3-month and 1-year mortality in a cohort of Chinese recipients. Surg Today. 2010;40:38–45. doi: 10.1007/s00595-009-4114-6. [DOI] [PubMed] [Google Scholar]
  • 30.Saab S, Niho H, Comulada S. Mortality predictors in liver transplant recipients with recurrent hepatitis C cirrhosis. Liver Int. 2005;25:940–945. doi: 10.1111/j.1478-3231.2005.01120.x. [DOI] [PubMed] [Google Scholar]
  • 31.Wiesner R, Edwards E, Freeman R. United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–96. doi: 10.1053/gast.2003.50016. [DOI] [PubMed] [Google Scholar]
  • 32.Huo Tl, Lin HC, Lee FY. Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline modelforend-stage liver disease score. Liver Int. 2006;26:55–61. doi: 10.1111/j.1478-3231.2005.01190.x. [DOI] [PubMed] [Google Scholar]

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