[Usefulness of DeltaMELD/month for prediction of the mortality in the first episode of variceal bleeding patients with liver cirrhosis: comparison with CTP, MELD score and DeltaCTP/month].
OBJECTIVE
There are many models for predicting prognosis of liver cirrhosis including Child Turcotte Pugh (CTP), the model for end-stage liver disease (MELD) score and its changes over time (DeltaCTP and DeltaMELD/month). We investigated the ability of these models to predict the mortality of liver cirrhosis patients with the first episode of variceal bleeding and which model can be usefully applied in practice.


METHODS
Seventy-one liver cirrhosis patients hospitalized for the first episode of esophageal variceal bleeding were retrospectively analyzed. The predictive power of initial CTP, MELD score, DeltaCTP and DeltaMELD/month was compared through c-statistics and multiple logistic regression.


RESULTS
All of the prognostic predictors measured higher in patients who survived than in those who died. The area under the receiver operating characteristic (ROC) curve for DeltaMELD/month in 6 months was 1, a higher value than 0.81 for initial CTP, 0.75 for initial MELD, and 0.84 for DeltaCTP/month; the area of DeltaMELD/month in 12 months was 0.81, also showing a higher value than others. DeltaMELD/month >0.27 was a strong significant prognostic predictor in 6 (odds ratio: 40.1, p=0.001) and 12 months (odds ratio: 14.1, p<0.001). Only the DeltaMELD/month was an independent prognostic predictor with a risk ratio of 1.604 (95% CI: 1.119-2.302, p=0.01) in 6 months and 1.627 (95% CI: 1.294-2.047, p<0.001) in 12 months.


CONCLUSIONS
The DeltaMELD/month is superior to initial CTP, MELD and DeltaCTP/month to predict 6 and 12 months mortality in liver cirrhosis patients with the first episode of variceal bleeding.
Bae
Won Ki
WK
Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Lee
June Sung
JS
Kim
Nam Hoon
NH
Kim
Kyung Ah
KA
Moon
Young Soo
YS
Oh
Min Kyung
MK
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors