The value of model for end-stage liver disease and Child-Turcotte-Pugh scores over time in evaluating the prognosis of patients with decompensated cirrhosis: experience in the Chinese mainland.

Aim: In addition to the model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) score, the change in MELD score (DeltaMELD) and CTP (DeltaCTP) over time, as well as the modified CTP score, have been proposed as predictive factors for patients with advanced liver cirrhosis. We investigated the ability of the above scoring systems to predict the outcome of decompensated cirrhosis in the Chinese mainland.

Methods: A cohort of 160 patients with advanced liver cirrhosis who were followed up were studied prospectively. Kaplan-Meier survival analysis was used to evaluate 3-month survival in categories ranked by MELD and DeltaMELD, CTP, DeltaCTP and modified CTP score respectively. The area under receiver operator characteristics curve (AUC) was used to determine the predictive abilities of these models for 3-month mortality. A multivariate logistic regression method was used to determine the factors associated with mortality.

Results: Forty-five patients (28%) died within 3 months. The AUC of the DeltaMELD (0.901) was significantly higher than that of the MELD score (0.828) and the CTP score (0.605) (P < 0.01). The differences remained significant between the AUC of the DeltaCTP and CTP score, modified CTP and CTP (P < 0.01). The AUC of DeltaCTP, modified CTP and MELD were not different from each other (P > 0.05). In multivariate analysis, MELD, CTP scores, DeltaMELD, DeltaCTP and modified CTP were independent predictors of 3-month mortality.

Conclusions: DeltaMELD, DeltaCTP and modified CTP were clinically useful parameters for short-term prognostication of patients with decompensated cirrhosis.