title: Model for End stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores: Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions.
abstract: BACKGROUND
  There are many patients awaiting liver transplantation with only few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizing patients on waiting lists. In this study, we compared the ability of these scores to predict mortality or removal from the waiting list due to poor medical conditions.
  
  
  METHODS
  A total of 257 patients were included in our study and we observed their status in the waiting list over a 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores.
  
  
  RESULTS
  During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for discriminating mortality or removal from the waiting list due to severe deterioration is 8 for CTP and 13.67 for MELD. The sensitivity and specificity was 0.74 and 0.67, respectively for CTP and 0.74 and 0.58, respectively for MELD.
  
  
  CONCLUSIONS
  The CTP score can predict mortality or removal from the liver transplantation waiting list better than the MELD over a 9-month period. However, better improved models need to be developed for prioritization of patients in the waiting list.
authors: School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.nourik@tums.ac.ir.
authors: Nasim
authors: N
authors: Rahimi-Dehkordi
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Keramat
authors: K
authors: Nourijelyani
authors: Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mohsen
authors: M
authors: Nasiri-Tousi
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Robabeh
authors: R
authors: Ghodssi-Ghassemabadi
authors: Pathology Department, Imam Khomeini Hospital, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors: Farid
authors: F
authors: Azmoudeh-Ardalan
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Saharnaz
authors: S
authors: Nedjat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D001201:Ascites; D001663:Bilirubin; D015331:Cohort Studies; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D006501:Hepatic Encephalopathy; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012709:Serum Albumin; D012720:Severity of Illness Index; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D001663:Bilirubin