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Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients.

ABSTRACT: Aim of the study:To assess the performance of Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores' kinetics during hospitalization in predicting in-hospital mortality in patients with liver cirrhosis. Material and methods:One hundred and seventy-four cases of hospitalized liver cirrhosis patients were selected. The diagnosis of cirrhosis was made based on clinical, biochemical, ultrasonic, histological, and endoscopic findings and results. CTP and MELD scores at admission and ?CTP and ?MELD were calculated. Univariate and multivariate logistic regression and receiver-operating characteristic (ROC) curve analysis were performed. In the models, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The area under the ROC curve (AUC) was used to measure the accuracy. For the optimal cutoff point, sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated. The Kaplan-Meier method was used to construct survival curves, and the log-rank test was used to compare time to death, with respect to MELD and CTP categories. Results:Among the assessed scores, the highest area under the ROC curve (AUC) in univariate logistic regression analysis was calculated for ?MELD ? 1, followed by ?CTP ? 1, CTP > 8, and MELD > 17. Based on the selected criteria, multivariate models were created that were characterized by an outstanding ability to predict the in-hospital mortality. Conclusions:In-hospital mortality is relatively high in patients with liver cirrhosis. The combination of CTP and MELD scoring methods, combined with their kinetics, allows for the prediction of short-term mortality.

SUBMITTER: Piotrowski D

PROVIDER: S-EPMC6311743 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

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Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients.

Piotrowski Damian D Sączewska-Piotrowska Anna A Jaroszewicz Jerzy J Boroń-Kaczmarska Anna A

Clinical and experimental hepatology 20181203 4

<h4>Aim of the study</h4>To assess the performance of Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores' kinetics during hospitalization in predicting in-hospital mortality in patients with liver cirrhosis.<h4>Material and methods</h4>One hundred and seventy-four cases of hospitalized liver cirrhosis patients were selected. The diagnosis of cirrhosis was made based on clinical, biochemical, ultrasonic, histological, and endoscopic findings and results. CTP and MELD sc ...[more]

PMID: 30603671

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Project description:BackgroundThe Model for End-Stage Liver Disease (MELD) predicts events in cirrhotic subjects undergoing major surgery and may offer similar prognostication in left ventricular assist device candidates with comparable degrees of multisystem dysfunction.Methods and resultsPreoperative MELD scores were calculated for subjects enrolled in the University of Michigan Health System (UMHS) mechanical circulatory support database. Univariate and multiple regression analyses were performed to investigate the ability of patient characteristics, laboratory data (including MELD scores), and hemodynamic measurements to predict total perioperative blood product exposure and operative mortality. The ability of preoperative MELD scores to predict operative mortality was evaluated in subjects enrolled in the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS), and results were compared with those from the UMHS cohort. The mean+/-SD MELD scores for the UMHS (n=211) and INTERMACS (n=324) cohorts were 13.7+/-6.1 and 15.2+/-5.8, respectively, with 29 (14%) and 19 (6%) perioperative deaths. In the UMHS cohort, median total perioperative blood product exposure was 74 units (25th and 75th percentiles, 44 and 120 units). Each 5-unit MELD score increase was associated with 15.1+/-3.8 units (beta+/-SE) of total perioperative blood product exposure. Each 10-unit increase in total perioperative blood product exposure increased the odds of operative death (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.10). Odds ratios, measuring the ability of MELD scores to predict perioperative mortality, were 1.5 (95% confidence interval, 1.1 to 2.0) and 1.5 (95% confidence interval, 1.1 to 2.1) per 5 MELD units for the UMHS and INTERMACS cohorts, respectively. When MELD scores were dichotomized as >or=17 and <17, risk-adjusted Cox proportional-hazard ratios for 6-month mortality were 2.5 (95% confidence interval, 1.2 to 5.3) and 2.5 (95% confidence interval, 1.1 to 5.4) for the UMHS and INTERMACS cohorts, respectively.ConclusionsThe MELD score identified left ventricular assist device candidates at high risk for perioperative bleeding and mortality.

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Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients.

Publications

Predictive power of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score for mortality in cirrhotic patients.

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