Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?
BACKGROUND
The model for end-stage liver disease (MELD) score is a useful tool to assess prognosis in critically ill cirrhotic patients. However, its short-term prognostic superiority over the traditional Child-Turcotte-Pugh (CTP) score has not been definitely confirmed. The creatinine serum level is an important predictor of survival in patients with liver cirrhosis.


OBJECTIVE
To evaluate and compare the short-term prognostic accuracy of the CTP, the creatinine-modified CTP, and the MELD scores in patients with liver cirrhosis.


METHODS
CTP, creatinine-modified CTP, and MELD scores were calculated in a cohort of 145 cirrhotic patients. The creatinine-modified CTP was calculated as follows: we assessed the mean creatinine serum level and standard deviation (SD) of the 145 study patients, then assigned a score of 1 to patients with creatinine serum levels < or = to the mean, a score of 2 to patients with creatinine levels between the mean and the mean+1 SD, and a score of 3 to patients with creatinine levels above the mean+1 SD. The creatinine-modified CTP was then calculated by simply adding each patients' creatinine score to their traditional CTP scores. We calculated and compared the accuracy (c-index) of the three parameters in predicting 3-month survival.


RESULTS
The creatinine-modified CTP score showed better prognostic accuracy as compared with the traditional CTP (P=0.049). However, the MELD score proved to be better at defining patients' prognosis in the short-term as compared with both the traditional CTP score (P=0.012) and the creatinine-modified CTP (P=0.047). The excellent short-term prognostic accuracy of the MELD score was confirmed even when patients with abnormal creatinine serum levels were excluded from the analysis (c-index=0.935).


CONCLUSIONS
Adding creatinine values to the CTP slightly improves the prognostic usefulness of the traditional CTP score alone. The MELD score has a short-term prognostic yield that is better than what is provided by both the CTP and CTP creatinine-modified scores, even in cirrhotic patients who are not critically ill. The positive results obtained by using the MELD score were confirmed even after excluding patients with impaired renal function.
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Italy.
Edoardo
E
Giannini
Federica
F
Botta
Alessandra
A
Fumagalli
Federica
F
Malfatti
Emanuela
E
Testa
Bruno
B
Chiarbonello
Simone
S
Polegato
Michele
M
Bellotti
Sara
S
Milazzo
Giacomo
G
Borgonovo
Roberto
R
Testa
D000368:Aged; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000473:pathology*; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D003404:Creatinine