title: Prognostic Models for Survival in Patients with Stable Cirrhosis: A Multicenter Cohort Study.
abstract: BACKGROUND
  Two models are mostly used to predict survival in cirrhosis: the Child-Pugh score (CP score) and the model for end-stage liver disease score (MELD score).
  
  
  OBJECTIVE
  The aim of this study is to evaluate the CP score and the MELD score for short- and long-term prognosis in cirrhosis, as well as CP-creatinine score, MELD-Na score, and UKELD score.
  
  
  METHODS
  One thousand and forty-seven patients from five referral centers were included: men/women: 620/427, median age: 58 years (IQR 48-66), median follow-up: 33 months (IQR 12-74), CP (A/B/C): 493/357/147, CP score: 7 (IQR 5-9), MELD score: 12 (IQR 9-16). The performance of each score was evaluated by the Cox hazard model in terms of their: discrimination ability (C-index and Somer's D) and calibration (3, 12 months). Internal validation was done with bootstrapping (100 samples).
  
  
  RESULTS
  Three hundred and fifty-two patients (33.6%) died. All scores were significantly associated with overall mortality, when assessed by univariate Cox analysis. CP-creatinine score performed significantly better than all other scores [bootstrap C-index 0.672, 95% CI 0.642-0.703, bootstrap Somer's D 0.344 (0.285-0.401)], apart from CP score, which showed similar performance. Inclusion in the multivariable Cox model of age together with CP-creatinine score improved the discriminative ability of the model [bootstrap C-index (95% CI) 0.700 (0.661-0.740)]. In terms of calibration, CP-creatinine score was the best for both 3- and 12-month survival in the total population.
  
  
  CONCLUSIONS
  CP score and CP-creatinine score have better prognostic value compared to MELD score, MELD-Na score, and UKELD score for predicting short- and long-term mortality in patients with stable cirrhosis.
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kalafateli
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zisimopoulos
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Vourli
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rigamonti
authors.affiliation: Fourth Department of Internal Medicine, Aristotle University Medical School, Hippokration General Hospital of Thessaloniki, Thessaloníki, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Goulis
authors.affiliation: Second Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Greece.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Manesis
authors.affiliation: Second Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Athens, Greece.
authors.forename: Spilios
authors.initials: S
authors.lastname: Manolakopoulos
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.affiliation: Department of Gastroenterology, Polyclinic General Hospital, Athens, Greece.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Diamantopoulou
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Thomopoulos
authors.affiliation: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Gogos
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.affiliation: Fourth Department of Internal Medicine, Aristotle University Medical School, Hippokration General Hospital of Thessaloniki, Thessaloníki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Akriviadis
authors.affiliation: Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Lambropoulou-Karatza
authors.affiliation: Department of Gastroenterology, University Hospital of Patras, Patras, Greece. chtriantos@hotmail.com.
authors.forename: Christos
authors.initials: C
authors.lastname: Triantos
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
keywords: Cirrhosis; Cox proportional hazards models; Liver diseases; Prognosis; Survival