Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics

Abstract

The objective of this study was to assess the prognostic validity of Child-Turcotte classification with regard to short-term (1-year) survival. The Child-Turcotte classification, as modified by Pugh et al., was recorded on admission in 177 cirrhotic patients. The variables that comprise the Pugh modification are ascites, encephalopathy, serum albumin, serum bilirubin and prothrombin time. Using multiple logistic regression, we evaluated the contribution of different models to the likelihood of survival, defining different ways to use the Pugh score. The Pugh score categorized in three strata (5 to 6, 7 to 9 and 10 to 15) captured less variance in the survival than the Pugh score counted from 5 to 15. This, in turn, captured less variance than a model in which the parameters of the Pugh score were analyzed according to their original units. The prediction rule based on the last model was tested in another sample of cirrhotics. The "original unit" model was studied in both training and testing samples, using receiver-operating characteristic curves to evaluate its clinical validity (sensitivity and specificity). The prediction rule based on the "original units" Pugh score allowed for a good discrimination of patients who lived and those who died. (At the point of maximum discrimination, sensitivity and specificity reached a mean of 80%). Validity of the prediction rule was confirmed by the testing sample. The qualities of simplicity, availability, low cost and good discriminating power for a life or death outcome make the Pugh score a very useful method to estimate prognosis in patients with cirrhosis.

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

“…The C-P score is a well-accepted parameter for assessing the prognosis of cirrhotic patients [22], especially before transplantation [23,241, and constitutes the essence of the UNOS score [25] and MUC [ll] for the allocation of organs to liver transplant candidates. However, it uses discrete cut-off points and two parameters (degree of ascites and encephalopathy) which lack objectivity and precision, thus explaining its poor reproducibility among different hepatologists [26].…”

Predictors of psychiatric disorders in liver transplantation candidates: Logistic regression models

“…Patients were considered for OLT if liver function suggested a poor prognosis, correlated with Child-Pugh score B or C. Child-Pugh classification is a prognostic index that has been used extensively to risk stratify patients with cirrhosis and evaluate the efficacy of therapeutic procedures, e.g., sclerotherapy, band ligation, transjugular intrahepatic portosystemic shunt placement, and surgical procedures. [18][19][20][21][22] Child-Pugh grading of liver cirrhosis (grades A, B, and C) includes clinical (degree of ascites and hepatic encephalopathy [HE]) and laboratory parameters (values for albumin, prothrombin time, and bilirubin). 23 We excluded patients transferred from intensive care units and those affected by acute complicated liver disorders.…”

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

“…The Child-Turcott score [1] and its subsequent modifications by Pugh [8] are old empirical methods used to assess the degree of liver failure in candidate patients for porto-systemic shunt. Although the statistical accuracy of the Child-Pugh score (CPS) was not assessed, it was long considered to be an adequate method to determine the degree of liver failure, and the probability of survival [13]- [15]. However, two of its elements are very subjective (ascites and encephalopathy) [5].…”