MELD era: is this time to replace the original Child-Pugh score in patients with decompensated cirrhosis of liver.

Objective: 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.

Study Design: Descriptive study.

Place And Duration Of Study: Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007.

Methodology: 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.

Results: 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).

Conclusion: The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study.