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; Ramesh Chillal Kashinath; Ajay Duseja; Radha K Dhiman

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

J Clin Exp Hepatol. 2011 Dec;1(3):161-8. doi: 10.1016/S0973-6883(11)60233-8. Epub 2012 Jan 2.

Authors

Yogesh K Chawla¹, Ramesh Chillal Kashinath¹, Ajay Duseja¹, Radha K Dhiman¹

Affiliation

¹ Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.

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: 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.