Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis

Abstract

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin Ͻ 2.3 g/dL, bilirubin Ͼ 8 mg/dL or prothrombin time prolongation Ͼ 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (ϭ0.59, PϽ 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (Pϭ0.450) and 0.809 for original CTP system (P Ͻ 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (Pϭ0.051 and Ͻ 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P Ͻ 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction. Patients with decompensated liver cirrhosis often have a limited survival, and liver transplantation is the only definite treatment modality to effectively prolong their lifespan. However, patients on the waiting list of transplantation far outnumber the potential cadaveric or living liver donors. As a result, the number of patients dying while on the waiting list is progressively increasing in recent years. 1The donor livers are allocated to the recipients according to the severity of underlying liver disease. The MELD (model for end-stage liver disease) score, which is based on the calculation from three biochemical parameters (serum bilirubin, prothrombin time, and creatinine), has been shown to more accurately predict the survival than the Child-Turcotte-Pugh (CTP) score in a recent multi-center study in the United States, 2 and the liver allocation system has changed from a statusbased algorithm to one using a continuous MELD severity scale to prioritize adult patients on the waiting list.3,4 Its accuracy for outcome prediction in patients with decompensated cirrhosis has also been validated in other centers and in Europe. 5-7Abbreviations: AUC, area under the curve; CTP, Child-Turcotte-Pugh; HBV, hepatitis B virus; HCV, hepatitis C virus; INR, international normalized ratio; MELD, model for end-stage liver disease; PT, prothrombin time; ROC, receiver operating characteristic curve.

Models for prediction of mortality from cirrhosis with special reference to artificial neural network: a critical review

“…Limitations of this scoring system for deciding timings of liver transplantation include limited discriminative ability, variability in measurement of clinical and laboratory determinants [7] of this scoring system and, importantly, limited ability to predict short-term mortality. Several other scoring systems have been described that attempt to evaluate prognosis of patients with cirrhosis of liver (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19]. However, none of these are applied widely in clinical practice because of their limited predictive ability and unacceptable complexity.…”

“…However, none of these are applied widely in clinical practice because of their limited predictive ability and unacceptable complexity. Recently, the Model for End-Stage Liver Disease (MELD) score has been adopted to measure disease severity, outcome, and as a basis of determination of organ allocation policies [13,[28][29][30][31][32]. Although the MELD score has become very popular within a short time after its introduction [7,19,33,34], it is not free from flaws.…”

Prognostic Factors for Survival in Patients with Liver Cirrhosis

“…Six scoring systems used, included the modified Child Pugh (MCTP) and the standard MELD, and four of its modifications. The modified CTP (Huo TI, 2006) was obtained by assigning an additional point in patients whose serum bilirubin was > 8 mg/dL, prothrombin time prolongation >11 seconds, or albumin <2.3 g/dL, accordingly a mCTP score of 16-18 was defined as class D, which identifies severely decompensated cirrhosis. In this study population, the prognostic power of mCTP did not differ from that of MELD, MELD-sodium and integrated MELD were the best prognostic models.…”

Liver Specific Serum Micro RNA122 as a Prognostic Marker in Egyptian Patients with Liver Cirrhosis

“…The Model of End Stage Liver Disease (MELD) score was originally developed to predict survival after Transjugular Intrahepatic Portosystemic shunt procedure and to prioritize patients waiting for liver transplantation [2]. It has been found to predict with accuracy short term mortality in various liver diseases [8]. However, the MELD score doesn't account for the presence of some complications of liver cirrhosis as ascites and encephalopathy which can be viewed as a shortcoming and it is unable to give accurate predictions for long term survival [9].…”