Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2005; 11(20): 3099-3104
Published online May 28, 2005. doi: 10.3748/wjg.v11.i20.3099
MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis
George V. Papatheodoridis, Evangelos Cholongitas, Eleni Dimitriadou, Giota Touloumi, Vassilios Sevastianos, Athanasios J. Archimandritis
George V. Papatheodoridis, Evangelos Cholongitas, Vassilios Sevastianos, Athanasios J. Archimandritis, 2nd Department of Internal Medicine, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece
Eleni Dimitriadou, Giota Touloumi, Department of Epidemiology, National University of Athens Medical School, Athens, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: George V. Papatheodoridis, MD, Assistant Professor in Medicine and Gastroenterology, 2nd Department of Internal Medicine, Medical School of Athens University, Hippokration General Hospital of Athens, 114 Vas. Sophias Ave., 115 27 Athens, Greece.
Telephone: +30-210-7774742 Fax: +30-210-7706871
Received: October 19, 2004
Revised: October 20, 2004
Accepted: January 5, 2005
Published online: May 28, 2005

AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatinine-modified Child-Pugh scores in decompensated cirrhosis.

METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied. Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated.

RESULTS: The areas under the receiver operating charac-teristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas: 0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis.

CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.

Keywords: Child-Pugh, MELD, Cirrhosis, Decompensated cirrhosis