Usefulness of delta MELD/month for Prediction of the Mortality in the First Episode of Variceal Bleeding Patients with Liver Cirrhosis: Comparison with CTP, MELD score and delta CTP/month / 대한간학회지

BACKGROUND/AIMS: There are many models for predicting prognosis of liver cirrhosis including Child Turcotte Pugh (CTP), the model for end-stage liver disease (MELD) score and its changes over time (delta CTP and delta MELD/month). We investigated the ability of these models to predict the mortality of liver cirrhosis patients with the first episode of variceal bleeding and which model can be usefully applied in practice. METHODS: Seventy-one liver cirrhosis patients hospitalized for the first episode of esophageal variceal bleeding were retrospectively analyzed. The predictive power of initial CTP, MELD score, delta CTP and delta MELD/month was compared through c-statistics and multiple logistic regression. RESULTS: All of the prognostic predictors measured higher in patients who survived than in those who died. The area under the receiver operating characteristic (ROC) curve for delta MELD/month in 6 months was 1, a higher value than 0.81 for initial CTP, 0.75 for initial MELD, and 0.84 for delta CTP/month; the area of delta MELD/month in 12 months was 0.81, also showing a higher value than others. delta MELD/month >0.27 was a strong significant prognostic predictor in 6 (odds ratio: 40.1, p=0.001) and 12 months (odds ratio: 14.1, p<0.001). Only the delta MELD/month was an independent prognostic predictor with a risk ratio of 1.604 (95% CI: 1.119-2.302, p=0.01) in 6 months and 1.627 (95% CI: 1.294-2.047, p<0.001) in 12 months. CONCLUSIONS: The delta MELD/month is superior to initial CTP, MELD and delta CTP/month to predict 6 and 12 months mortality in liver cirrhosis patients with the first episode of variceal bleeding.

Changes of MELD: Can Exceed Child-Pugh's Authority? / 대한간학회지

No abstract available.

Clinical Usefulness of delta MELD to Predict the Survival of Patients with Liver Cirrhosis / 대한간학회지

<0.001) compared with 0.575 for MELD score and 0.636 for CP score at 6 month-mortality; the area was 0.727, 0.594 and 0.657 at 12 month-mortality; 0.693, 0.587 and 0.639 at 24 month-mortality, respectively. The patients with delta MELD/month more than 1.0 had resulted in the higher mortality at 6, 12 and 24 months. The delta MELD/month was associated with mortality and was an independent prognostic predictor with a risk ratio of 1.679 (95% CI: 1.381-2.042, P<0.001). CONCLUSIONS: Determination of delta MELD could be better prognostic predictor for patients with liver cirrhosis than initial MELD and CP score.