MELD Era: Is This Time to Replace The Original Child-Pugh Score in Patients with Decompensated Cirrhosis of Liver

Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP (Impact Factor: 0.35). 07/2010; 20(7):432-5.
Source: PubMed


To compare the predictive value of MELD (Model of end stage liver disease) and Child-Pugh (CP) scores in patients with decompensated cirrhosis of liver.
Descriptive study.
Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007.
This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR (International normalized ratio) of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance.
There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76+12.93 years. There were 72 (65%) male and 38 (35%) females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 (60%) cases. Ascites was present in 93/110 (83%) patients. The mean MELD scores were 2.23+0.712 (95% CI 2.09 - 2.36) and for CTP 2.52+0.586 (95%; CI 2.41-2.63). The outcome of the patients were 12 deaths (11%); 54 (49%) remained hospitalized for up to 14 days and 44 (40%) for > 14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score > 15 as well as with Child-Pugh grade C. The c-statistic was 0.726 (p=0.001) for CP score, and 0.642 for MELD score (p=0.021).
The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study.

Download full-text


Available from: Samiullah Shaikh
  • Source
    • "The applicability of routine liver tests could not predict the anesthetic and surgical burden on liver; considering the ability of liver for extraction and detoxification of certain substance and excretion of its non-toxic metabolites either in biliary passages or blood sinusoids is one of the major functions of the liver and reflects its affection by pre-existing diseases or by risk-exposure [10] [11] [12]. MGEX is the major metabolism product of lidocaine and considering lidocaine as a substance not normally synthesized in the body, and subsequently, its metabolites are not present in circulation, so its estimation could reflect the detoxification and extraction function of the liver [8] [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To estimate plasma monoethylglycinexylidide (MEGX) level at 15 and 30 min after intravenous injection of lidocaine as a measure for detoxification and excretory function of the liver in cirrhotic patients in comparison with non-cirrhotic patients assigned for laparoscopic cholecystectomy (LC). Patients and methods The study included 50 cirrhotic and 10 non-cirrhotic patients assigned for LC. Only Child-Pugh (CP) class A or B patients with adjusted liver functions were included in the study. Both patients and controls received anesthesia using a similar protocol. Intravenous lidocaine (1 mg/kg) was injected over 1 min, and blood samples were obtained immediately before lidocaine injection (S0) to assure absence of MEGX in plasma and 15 min (S15) and 30 min (S30) after lidocaine administration. MEGX values > 90 ng/ml are considered normal. The extent of MEGX extraction was calculated as plasma MEGX level at S30 minus S15. Results Mean operative and anesthesia times were 59.3 ± 10.4 and 73.9 ± 12.2 min, respectively. Mean sevoflurane 18.1 ± 2.4 ml/h. Operative and anesthetic data showed non-significant difference between patients categorized according to CP class and in comparison with controls. Estimated plasma MEGX levels at 15-min and 30-min after lidocaine injection were significantly higher in controls compared to patients and in patients of CP class A compared to those of class B. The extent of extraction was significantly lower in patients of CP class B compared both to controls and patients of class A with non-significantly lower extraction level in patients of class A compared to controls. Conclusion Laparoscopic cholecystectomy is safe and feasible in cirrhotic patients and MEGX test as a measure of detoxification and excretory function of the liver is a reliable test that showed a relationship to the extent of hepatic derangement.
    Preview · Article · Jan 2013 · Egyptian Journal of Anaesthesia
  • [Show abstract] [Hide abstract]
    ABSTRACT: 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.ResultsScores 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.
    No preview · Article · Dec 2011 · Journal of Clinical and Experimental Hepatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate hepatic relaxation times T1, T2 and T2* in healthy subjects and patients with liver cirrhosis stratified by the Child-Pugh classification (CPC). Sixty-one consecutive patients were stratified by CPC (class A026; B020; C015) and compared with age-matched controls (n = 31). Relaxometry measurements were performed at 1.5 T using six saturation recovery times (200-3,000 ms) to determine liver T1, six echo times (TE 14-113 ms) for T2 and eight TE (4.8-38 ms) for T2* assessment. Signal intensities in selected regions of interest in the liver parenchyma were fitted to theoretical models with least squares minimisation algorithms to determine T1, T2 and T2*. The most significant difference was the higher T1 values (852 ± 132 ms) in cirrhotic livers compared with controls (678 ± 45 ms, P < 0.0001). A less significant difference was seen for T2* (23 ± 5 vs. 26 ± 7 ms). Subdifferentiation showed a statistically significant difference between control group and individual CPC classes as well as between class C and classes A or B for T1 relaxation times. Measurement of T1 relaxation time can differentiate healthy subjects from patients with liver cirrhosis, and can distinguish between mild/moderate disease (CPC A/B) and advanced disease (CPC C). • Significantly elevated magnetic resonance T1 relaxation times are found in liver cirrhosis. • T1 relaxation times can distinguish healthy subjects from patients with liver cirrhosis. • T1 relaxation times can distinguish Child-Pugh classes Aand B from C.
    No preview · Article · Feb 2012 · European Radiology