Aminopyrine breath test compared to the MELD and Child-Pugh scores for predicting mortality among cirrhotic patients awaiting liver transplantation

Abstract

Better tools for predicting the risk of death while awaiting transplantation are urgently needed because organ shortage is increasing the numbers on transplantation waiting lists. The aminopyrine breath test (ABT), model for endstage liver disease (MELD), and Child-Pugh (C-P) score were compared as predictors of this risk in 137 cirrhotic candidates for liver transplantation. Eighty-three were transplanted within 3 months of registration, 35 others survived, 13 died before transplantation, and 6 were removed from the list. By univariate analysis, the continuous variables significantly associated with death while awaiting transplantation were: history of infected ascites, C-P score, ABT, and international normalized ratio or prothrombin time. Receiver operating characteristic curves for quantitative variables showed that the area under the curve was greatest for ABT (0.858 * 0.067). By Youden curve analysis, the best cut-off points for identifying cirrhotic patients at high risk of death while on the waiting list were: > 10, > 16, and <0.7% for the C-P score, MELD score, and ABT, respectively. These results show that ABT is as good as the MELD and C-P scores, or better, as a predictor of death among cirrhotic patients awaiting liver transplantation.

Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD

“…Nonetheless, for the assessment of individuals at the bedside, it can be anticipated that Child-Pugh will resist as an almost intuitive score which can be combined easily with other clinical information. [48] 2003 Cirrhosis, LT 3437 3-month mortality 0.76 0.83 Degré D et al [50] 2004 Cirrhosis, LT 137 3-month mortality 0.72 0.70 Said A et al [30] 2004 Chronic liver diseases 1611 3-year mortality 0.83 0.79 Concordance (c) statistic represents the area under receiving-operating-characteristic (ROC) curve, plotting sensitivity against 1-specificity. This statistic, ranging from 0 to 1, is an global marker of the validity of the score for predicting the event.…”

“…A surprising finding is that despite MELD score represents a determinant progress in terms of methodology and validation, its accuracy for predicting outcome in cirrhotic patients, as shown in Table 4, is not always superior (and may even be inferior) to that of Child score [49,50]. Receiving-operating-characteristic (ROC) curve and the derived c statistic provide a global and standardized appreciation of the accuracy of a marker or a composite score for predicting an event.…”

30 Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the eurotransplant allocation system

“…This underlines the fact that the critical threshold may be lower for HCC than for patients with cirrhosis without HCC, for whom the CTP has been estimated at 11. 26 It must be emphasized that for our patients listed for HCC and not for end-stage liver disease, the MELD score was not a predictive factor of LTX failure, when competing with the CTP score in the multivariate analysis. Moreover, it was not statistically significant (P ϭ 0.67; data not shown) in the univariate analysis.…”

Critical appraisal of 13C breath tests for microsomal liver function: aminopyrine revisited

“…The breath test had a high prognostic value for survival and short-term survival [q = 0.73 (95% CI 0.66-0.81)], and correlated with the Child-Pugh score better than with the MELD-score (q = 0.72 and q = 0.60 respectively). Degre et al (45) further showed that the 13 C 2 -aminopyrine breath test has a greater area under curve than both the Child-Pugh and the MELD scores in cirrhotic patients awaiting transplantation, suggesting that the breath test is as good as or better in predicting mortality. In post-transplantation settings, the combination of the 13 C 2 -aminopyrine and the 13 C-methionine breath test (for mitochondrial function) could be used to evaluate the functioning of the orthotopic transplant liver to predict graft outcome (40).…”