BICEPS another score for the assessment of severity of liver cirrhosis

ABSTRACT

Background and Aim: The clinical assessments using the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease-sodium (MELD-Na) scores are heterogeneous. The present study aims to collate most relevant markers of chronic liver disease as a new score BICEPS (Bilirubin, INR, Creatinine, Encephalopathy, Platelet and Sodium) an alternate to CTP and MELD-Na in patients diagnosed with liver cirrhosis. Methods: From January 2019 till December 2021, patients who were admitted with a diagnosis of liver cirrhosis were included. Patients were classified as per the CTP, MELD-Na and BICEPS scoring systems using a proforma. The BICEPS score is created by the authors and study intended to validate clinically. Results: In 211 patients, were evaluated during the study period including COVID pandemic period. The mean MELD-Na score was 23.49 ± 8.42, ranging 7 to 42, while CTP score ranged from 5 to 15, with a mean value of 9.65 ± 2.76. We classified patients as per scoring to 16%, 32% and 52% as Grade A, B and C on CTP respectively and 6%, 54% and 40% as Grade A, B and C on BICEPS respectively. We observed moderate level of agreement between BICEPS and CTP [Cohen’s kappa = 0.57, 95% confidence interval (CI) 0.45 to 0.69, p value < 0.01]. BICEPS correlated strongly with both MELD-Na [Pearson’s correlation coefficient (r) = 0.84, p value < 0.01] and CTP (r = 0.83, p value < 0.01). Conclusions: BICEPS yet another clinical scoring that has a moderate level of agreement with CTP and significant correlation with both CTP and MELD Na. Being a clinical scoring helps bedside estimation easy and includes all the 6 critical markers of CLD and is comparable to MELD Na without a calculator. Further studies are required with more number of patients for validating the BICEPS score.