Improvement of prognostic power of the Child-Pugh classification of liver cirrhosis by hyaluronan.
OBJECTIVE
Modifications of the Child-Pugh classification of liver cirrhosis by incorporation of hyaluronan were tested to improve the prognostic power for long term evaluation of liver cirrhosis in 126 patients observed over a period of 10 years.


METHODS
Serum concentrations of HA were determined at study entry. Statistical analysis included Kaplan-Meier life tables and stepwise multivariant Cox-regression analysis for each parameter of Child-Pugh classification and hyaluronan. Prognostic models were developed by exchanging prothrombin time, albumin and encephalopathy by HA in different combinations.


RESULTS
Based on a good single correlation between hyaluronan (0.62) and clinical course (P<0.01) we conclude that models with hyaluronan instead of albumin or encephalopathy and with or without shifted threshold values of bilirubin and albumin are superior for the prediction of the long term prognosis. In Cox-regression analysis, apart from hyaluronan and bilirubin, no other parameters contributed to an improvement.


CONCLUSIONS
We conclude that a modification of the Child-Pugh classification of liver cirrhosis by inclusion of HA significantly improves the predictive power of CP, especially in alcoholic etiology. A prospective validation of the newly defined scores needs to be done in the future.
Körner
Thomas
T
Klinik für Innere Medizin II, Zentralklinikum Suhl gGmbH, Suhl, Germany.
Kropf
Jürgen
J
Kosche
Britta
B
Kristahl
Hartmut
H
Jaspersen
Daniel
D
Gressner
Axel M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016326:Extracellular Matrix Proteins / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000145:classification / Q000401:mortality; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood / Q000145:classification* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011517:Prothrombin Time; D012709:Serum Albumin; D016019:Survival Analysis
D015415:Biomarkers; D016326:Extracellular Matrix Proteins; D012709:Serum Albumin; D006820:Hyaluronic Acid