Predicting Mortality Across a Broad Spectrum of Liver Disease-An Assessment of Model for End-Stage Liver Disease (MELD), Child-Turcotte-Pugh (CTP), and Creatinine-Modified CTP Scores

Overview

Journal J Clin Exp Hepatol

Publisher Elsevier

Specialty Gastroenterology

Date 2015 Mar 11

PMID 25755381

Citations 11

Authors

Yogesh K Chawla

Ramesh Chillal Kashinath

Ajay Duseja

Radha K Dhiman

Affiliations

Soon will be listed here.

Abstract

Background/aims: The role of model for end-stage liver disease (MELD) among Indian patients with cirrhosis is uncertain. We studied and compared MELD with Child-Turcotte-Pugh (CTP) and creatinine-modified-CTP (CrCTP) scores for predicting 1-, 3-, and 6-months mortality.

Methods: One-hundred and two patients with cirrhosis were studied. The CrCTP was calculated by adding creatinine score of 0, 2 and 4 with creatinine levels of ≤1.2mg/dL, 1.3-1.8 mg/dL and ≥1.9mg/dL, respectively to CTP score. Survival curves were plotted and receiver operating characteristics (ROC) curves were used to compare the scores. Predictors of mortality were analyzed using Cox proportional hazards model.

Results: Scores of CTP, CrCTP, and MELD have excellent diagnostic accuracy for predicting mortality (c-statistics >0.85). The MELD was superior to CTP for predicting 3-months [c-statistic and 95% confidence interval, 0.967 (0.911-0.992) vs 0.884 (0.806-0.939)] and 6-months [0.977 (0.925-0.996) vs 0.908 (0.835-0.956)] mortality (P=0.05), while CrCTP [0.958 (0.899-0.988)] was better than CTP for predicting 3-months mortality (P=0.02). Serum creatinine (hazard ratio 4.43, P<0.0001) is a strong independent predictor of mortality.

Conclusion: The MELD accurately predicts mortality in cirrhosis and is better than CTP for predicting the short-term and intermediate-term mortality. Adding serum creatinine to CTP though significantly improves its diagnostic accuracy for short-term mortality; however, it remains lower than MELD alone.

Citing Articles

Do Child-Turcotte-Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study.

Carteri R, Marroni C, Ferreira L, Pinto L, Czermainski J, Tovo C World J Hepatol. 2025; 17(1):99183.

PMID: 39871909 PMC: 11736485. DOI: 10.4254/wjh.v17.i1.99183.

Comparison of different severity scores in correlating hemoglobin levels with the severity of hepatic decompensation: An observational study.

Ullah H, Huma S, Yasin G, Ashraf M, Tahir N, Tahir Uddin Q World J Hepatol. 2025; 17(1):101212.

PMID: 39871907 PMC: 11736469. DOI: 10.4254/wjh.v17.i1.101212.

Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis.

Swaroop S, Vaishnav M, Arora U, Biswas S, Aggarwal A, Sarkar S J Clin Exp Hepatol. 2024; 14(2):101291.

PMID: 38544766 PMC: 10964076. DOI: 10.1016/j.jceh.2023.10.002.

A Validated Composite Score Demonstrates Potential Superiority to MELD-Based Systems in Predicting Short-Term Survival in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis-A Preliminary Study.

Lin Y, Chen W, Wu T, Liu Y, Liu L, Teng W Diagnostics (Basel). 2023; 13(15).

PMID: 37568941 PMC: 10417459. DOI: 10.3390/diagnostics13152578.

Overview of Complications in Cirrhosis.

Premkumar M, Anand A J Clin Exp Hepatol. 2022; 12(4):1150-1174.

PMID: 35814522 PMC: 9257866. DOI: 10.1016/j.jceh.2022.04.021.

References

Shaikh S, Ghani H, Memon S, Baloch G, Jaffery M, Shaikh K . MELD era: is this time to replace the original Child-Pugh score in patients with decompensated cirrhosis of liver. J Coll Physicians Surg Pak. 2010; 20(7):432-5. DOI: 07.2010/JCPSP.431435. View

Hanley J, McNeil B . A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983; 148(3):839-43. DOI: 10.1148/radiology.148.3.6878708. View

Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P, Uriz J, Quinto L, Ventura P . A prognostic model for predicting survival in cirrhosis with ascites. J Hepatol. 2001; 34(1):46-52. DOI: 10.1016/s0168-8278(00)00011-8. View

Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A . Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol. 2004; 40(6):897-903. DOI: 10.1016/j.jhep.2004.02.010. View

Pagliaro L . MELD: the end of Child-Pugh classification?. J Hepatol. 2002; 36(1):141-2. DOI: 10.1016/s0168-8278(01)00302-6. View

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A . Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35(3):716-21. DOI: 10.1053/jhep.2002.31250. View

Llovet J, Planas R, Morillas R, Quer J, Cabre E, Boix J . Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study. Am J Gastroenterol. 1993; 88(3):388-92. View

Kamath P, Wiesner R, Malinchoc M, Kremers W, Therneau T, Kosberg C . A model to predict survival in patients with end-stage liver disease. Hepatology. 2001; 33(2):464-70. DOI: 10.1053/jhep.2001.22172. View

Dhiman R, Makharia G, Jain S, Chawla Y . Ascites and spontaneous bacterial peritonitis in fulminant hepatic failure. Am J Gastroenterol. 2000; 95(1):233-8. DOI: 10.1111/j.1572-0241.2000.01691.x. View

10.

Giannini E, Botta F, Testa R . Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology. 2003; 125(3):993-4; author reply 994-5. DOI: 10.1016/s0016-5085(03)01147-8. View

11.

Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J . Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut. 2003; 52(6):879-85. PMC: 1773665. DOI: 10.1136/gut.52.6.879. View

12.

Dhiman R, Kurmi R, Thumburu K, Venkataramarao S, Agarwal R, Duseja A . Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci. 2010; 55(8):2381-90. DOI: 10.1007/s10620-010-1249-7. View

13.

Papatheodoridis G, Cholongitas E, Dimitriadou E, Touloumi G, Sevastianos V, Archimandritis A . MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis. World J Gastroenterol. 2005; 11(20):3099-104. PMC: 4305847. DOI: 10.3748/wjg.v11.i20.3099. View

14.

Hanley J, McNeil B . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143(1):29-36. DOI: 10.1148/radiology.143.1.7063747. View

15.

Huo T, Lin H, Lee F, Hou M, Lee P, Wu J . Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline model for end-stage liver disease score. Liver Int. 2006; 26(1):55-61. DOI: 10.1111/j.1478-3231.2005.01190.x. View

16.

Botta F, Giannini E, Romagnoli P, FASOLI A, Malfatti F, Chiarbonello B . MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut. 2002; 52(1):134-9. PMC: 1773509. DOI: 10.1136/gut.52.1.134. View

17.

Wiesner R, McDiarmid S, Kamath P, Edwards E, Malinchoc M, Kremers W . MELD and PELD: application of survival models to liver allocation. Liver Transpl. 2001; 7(7):567-80. DOI: 10.1053/jlts.2001.25879. View

18.

Forman L, Lucey M . Predicting the prognosis of chronic liver disease: an evolution from child to MELD. Mayo End-stage Liver Disease. Hepatology. 2001; 33(2):473-5. DOI: 10.1053/jhep.2001.22481. View

19.

Schepke M, Roth F, Fimmers R, Brensing K, Sudhop T, Schild H . Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting. Am J Gastroenterol. 2003; 98(5):1167-74. DOI: 10.1111/j.1572-0241.2003.07515.x. View

20.

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P . Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003; 124(1):91-6. DOI: 10.1053/gast.2003.50016. View