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

“…The most important prognostic scores are the Child-Turcotte-Pugh (CTP) score, developed in 1973 by Pugh's modification of the Child-Turcotte score [7] , and the Model for End-Stage Liver Disease (MELD) score, which was originally developed to predict 3-month survival in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt [8] . In 2003, the CTP score was remodeled by the inclusion of the serum creatinine level in the formula [9] , which has improved its predictive accuracy and justified the wider use of the CTP score in day-to-day clinical practice [10,11] .…”

Section: Introductionmentioning

confidence: 99%

Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores

Radisavljevic

Bjelaković²,

Nagorni³

et al. 2016

Med Princ Pract

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Objective: To identify the prognostic score that is the best predictor of outcome in patients hospitalized with decompensated liver cirrhosis. Material and Methods: In thisprospective study, 126 patients were enrolled and followed up for 29 months. For each patient, prognostic scores were calculated; these included the Child-Turcotte-Pugh score (CTP score), CTP creatinine-modified I score, CTP creatinine-modified II score, Model for End-Stage Liver Disease (MELD score), MELD model for end-stage liver disease sodium-modified score, Integrated MELD score, updated MELD score, United Kingdom MELD, and the MELD score remodeled by serum sodium index (MESO index). Cox regression analysis was used to assess the ability of each of the scores for predicting mortality in patients with alcoholic cirrhosis. Their discriminatory ability was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The updated MELD score had the highest predictive value (3.29) among the tested scores (95% CI: 2.26-4.78). ROC curve analysis demonstrated that the MELD score of 22.50 (AUC = 0.914, 95% CI: 0.849-0.978; p < 0.001) had the best discriminative ability for identifying patients with a high risk of mortality; the next best was the MESO index of 16.00 (AUC = 0.912, 95% CI: 0.847-0.978; p < 0.001). Conclusion: The risk of mortality was highest in patients with the highest updated MELD score, and those with MELD scores >22.50 and a MESO index >16.00.

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“…3,4 Crucially, antiviral treatments are reducing viral liver disease, permitting non-alcoholic fatty and alcoholic liver disease, including alcoholic hepatitis in recent years, to emerge as the leading indications for listing. [8][9][10][11][12] Various modifications, mostly based on the MELD, have been proposed over the years to address the MELD's shortcomings in certain conditions such as acute liver failure, acute-on-chronic liver failure, hepatorenal syndrome, bacterial infection, encephalopathy, and more. [8][9][10][11][12] Various modifications, mostly based on the MELD, have been proposed over the years to address the MELD's shortcomings in certain conditions such as acute liver failure, acute-on-chronic liver failure, hepatorenal syndrome, bacterial infection, encephalopathy, and more.…”

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confidence: 99%

The decreasing predictive power of MELD in an era of changing etiology of liver disease

Godfrey

Malik

Lai

et al. 2019

American Journal of Transplantation

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The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de‐identified data on 120 156 patients listed for liver transplant from 2002‐2016. The ability of the MELD score to predict 90‐day mortality was evaluated by a concordance (C‐) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90‐day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV‐positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73, <60 = 0.74), but is lower in diseases that are increasing most rapidly—alcoholic liver disease and non‐alcoholic fatty liver disease—and higher in those that are declining, particularly in HCV‐positive patients (HCV positive = 0.77; negative = 0.73). While MELD still predicts mortality, its accuracy has decreased; changing etiology of disease may contribute.

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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

Cited by 22 publications

References 32 publications

Creatinine modified Child–Turcotte–Pugh and integrated model of end‐stage liver disease scores as predictors of spontaneous bacterial peritonitis‐related in‐hospital mortality: Applicable or not

Creatinine modified Child–Turcotte–Pugh and integrated model of end‐stage liver disease scores as predictors of spontaneous bacterial peritonitis‐related in‐hospital mortality: Applicable or not

Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores

The decreasing predictive power of MELD in an era of changing etiology of liver disease

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