A combination of models for end-stage liver disease and cirrhosis-related complications to predict the prognosis of liver cirrhosis.
BACKGROUND
The Child-Pugh score, the model for end-stage liver disease (MELD) score, and the occurrence of cirrhosis-related complications are independent prognostic predictors used in the assessment of chronic liver diseases.


OBJECTIVE
The objectives of this study were to determine the best prognostic scoring system, and to create a combined method to predict the prognosis of liver cirrhosis more accurately.


METHODS
We retrospectively reviewed 435 cirrhotic patients from January 2009 to June 2010 and evaluated their short- and medium-term survival. Child-Pugh, MELD and its advanced scoring systems were computed for each patient. The sensitivity and specificity of these scoring systems were analyzed and their validity was assessed using concordance (c)-statistics in predicting the prognosis of cirrhotic patients.


RESULTS
Overall, 107 patients died within 6 months and 150 patients died within 1 year. The clinical and biochemical characteristics, cirrhosis-related complications, and the scores were significantly different among the survivors and patients who died. The largest area under the receiver operating characteristic curve was 0.741 for the integrated MELD (iMELD) at 6 months and 0.713 for iMELD at 12 months, indicating that iMELD was the best scoring system tested. Given this result, we created a new scoring system that combined iMELD and an index of cirrhosis-related complications, called iMELD-C. This novel system had c indexes of 0.758 for the 6-month survival and 0.746 for the 1-year survival.


CONCLUSIONS
The iMELD-C score is a better predictor of both short- and medium-term survival in patients with cirrhosis.
Department of Gastroenterology, Sun Yai-Sen Memorial Hospital, Sun Yai-Sen University, 14th Floor of Lingnan Building, No. 107, Yanjiang West Road, 510000 Guangzhou, China.
Qiu-Bo
QB
Zhang
Yin-Ting
YT
Chen
Guo-Da
GD
Lian
Chen-Chen
CC
Qian
Shao-Jie
SJ
Chen
Kai-Hong
KH
Huang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058625:End Stage Liver Disease / Q000150:complications*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult