MELD Era: is this time to replace the original child-pugh score in patients with decompensated cirrhosis of liver

ABSTRACT

To compare the predictive value of MELD [Model of end stage liver disease] and Child-Pugh [CP] scores in patients with decompensated cirrhosis of liver. Descriptive study. Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007. This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR [International normalized ratio] of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance. There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76 +/- 12.93 years. There were 72 [65%] male and 38 [35%] females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 [60%] cases. Ascites was present in 93/110 [83%] patients. The mean MELD scores were 2.23 +/- 0.712 [95% CI 2.09-2.36] and for CTP 2.52 +/- 0.586 [95%; CI 2.41-2.63]. The outcome of the patients were 12 deaths [11%]; 54 [49%] remained hospitalized for up to 14 days and 44 [40%] for>14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score>15 as well as with Child-Pugh grade C. The c-statistic was 0.726 [p=0.001] for CP score, and 0.642 for MELD score [p=0.021]. The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study