Assessment of a modified Child-Pugh-Turcotte score to predict early mortality after liver transplantation.
OBJECTIVE
The Model for End-Stage Liver Disease (MELD) predicts mortality on the transplant list; however, it has not been of much use to predict posttransplant outcomes. Several prognostic models have been tested among patients with cirrhosis; nevertheless, their predictive value has not been established in the posttransplant setting. We recently modified the Child-Pugh-Turcotte (CPT) score by adding creatinine levels (CPT + Cr), which has proven useful for patients with alcoholic cirrhosis. This retrospective analysis sought to predict early (1 month) mortality using CPT + Cr versus 5 other prognostic models in patients who underwent orthotopic liver transplantation (OLT) at our center.


METHODS
We included 48 consecutive patients (30 males, 18 females, median age 51 years). The predictive values of CPT + Cr were compared with CPT scores without or with the Huo modification, CPT + Na, MELD, and MESO, which is the MELD to serum Na ratio. Pearson correlations and ROC curves as evidenced by the area under the curve (AUC) were determined for each index. P < .05 was considered to be significant.


RESULTS
CPT + Cr showed the highest correlation with the risk of death (r = .368, P = .01); MELD and MESO were the lowest (r = .204, P = NS; and r = .254, P = NS, respectively). ROC analysis showed the best predictive value of CPT and CPT-Crea with AUC of 0.758 (P = .010) and 0.748 (P = .011) respectively, as compared to 0.689 for MESO and 0.659 for MELD (both NS).


CONCLUSIONS
A modified CPT score with creatinine levels may be of value to predict early death after OLT. Its usefulness must be validated in a prospective study of a large patient cohort.
Raszeja-Wyszomirska
J
J
Department of Hepatology and Liver Transplantation, M. Curie Hospital, Szczecin, Poland; Liver Unit, Pomeranian Medical School, 71-455 Szczecin, Poland.
Wasilewicz
M P
MP
Wunsch
E
E
Szymanik
B
B
Jarosz
K
K
Wójcicki
M
M
Milkiewicz
P
P
D000328:Adult; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000601:surgery; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors
D003404:Creatinine; D001663:Bilirubin