title: The performance of prognostic models as predictors of mortality in patients with acute decompensation of cirrhosis.
abstract: BACKGROUND
  Although several prognostic models have been proposed for cirrhotic patients listed for transplantation, the performance of these scores as predictors of mortality in patients admitted for acute decompensation of cirrhosis has not been satisfactorily investigated.
  
  
  OBJECTIVE
  To study MELD, MELD-Na, MESO, iMELD, Refit-MELD and Refit MELD-Na models as prognostic predictors in cirrhotic patients admitted for acute decompensation, and to compare their performance between admission and 48 hours of hospitalization to predict in-hospital mortality.
  
  
  METHODS
  This cohort study included cirrhotic patients admitted to hospital due to complications of the disease. Individuals were evaluated on admission and after 48 h of hospitalization, and mortality was evaluated during the present admission.
  
  
  RESULTS
  One hundred and twenty-three subjects with a mean age of 54.26 ± 10.79 years were included; 76.4% were male. Mean MELD score was 16.43 ± 7.08 and 52.0% of patients were Child-Pugh C. Twenty-seven patients (22.0%) died during hospitalization. Similar areas under the curve (AUROCs) for prognosis of mortality were observed when different models were compared on admission (P > 0.05) and after 48 h of hospitalization (P > 0.05). When models executed after 48 h of hospitalization were compared to their corresponding model calculated on admission, significantly higher AUROCs were obtained for all models (P < 0.05), except for MELD-Na (P = 0.075) and iMELD (P = 0.119).
  
  
  CONCLUSIONS
  The studied models showed similar accuracy as predictors of in-hospital mortality in cirrhotic patients admitted for acute decompensation. However, the performance of these models was significantly better when applied 48 h after admission when compared to their calculation on admission.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fayad
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Janaína Luz
authors.initials: JL
authors.lastname: Narciso-Schiavon
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: César
authors.initials: C
authors.lastname: Lazzarotto
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Marcelo Fernando
authors.initials: MF
authors.lastname: Ronsoni
authors.affiliation: Department of Clinical Analysis, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Letícia Muraro
authors.initials: LM
authors.lastname: Wildner
authors.affiliation: Department of Clinical Analysis, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Bazzo
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Leonardo de Lucca
authors.initials: Lde L
authors.lastname: Schiavon
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina (UFSC). Brazil.
authors.forename: Esther Buzaglo
authors.initials: EB
authors.lastname: Dantas-Corrêa
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000150:complications / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index