title: Do chronic liver disease scoring systems predict outcomes in trauma patients with liver disease? A comparison of MELD and CTP.
abstract: BACKGROUND
  Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. Currently, data regarding the use of CTP in trauma is limited, whereas MELD remains unstudied. We compared MELD and CTP to determine which scoring system is a better clinical outcome predictor after trauma.
  
  
  METHODS
  A review of trauma admissions during 2003-2008 revealed 68 patients with chronic liver disease. Single and multiple variable analyses determined predictors of hepatic complications and survival. MELD and CTP were compared using odds ratios and area under the receiver operating curve (AUC) analyses. A p value ≤0.05 was significant.
  
  
  RESULTS
  The mean MELD and CTP scores of the population were 13.1 ± 6.0 and 8.3 ± 1.8, respectively (mean ± SD). Overall, 73.5% had one or more complications and 29.4% died. When survivors were compared with nonsurvivors, no difference in mean MELD scores was found, although mean CTP score (survivors, 7.7 ± 1.5; nonsurvivors, 9.4 ± 1.9; p = 0.001) and class ("C" survivors, 12.1%; "C" nonsurvivors, 56.3%; p = 0.002) were different, with survival relating to liver disease severity. Odds ratios and AUC determined that MELD was not predictive of hepatic complications or hospital survival (p > 0.05), although both CTP score and class were predictive (p < 0.05; AUC > 0.70).
  
  
  CONCLUSIONS
  Trauma patients suffering from cirrhosis can be expected to have poorer than predicted outcomes using traditional trauma scoring systems, regardless of injury severity. Scoring systems for chronic liver disease offer a more effective alternative. We compared two scoring systems, MELD and CTP, and determined that CTP was the better predictor of hepatic complications and survival in our study population.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19104, USA. mark.seamon@tuhs.temple.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Franco
authors.forename: S Peter
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Brian P
authors.initials: BP
authors.lastname: Smith
authors.forename: Heather
authors.initials: H
authors.lastname: Kulp
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
mesh_terms: D002908:Chronic Disease; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality