MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis

Table 1 Baseline characteristics of 102 patients with decompensated cirrhosis.

Age (yr)	61 (27-89)
Sex, males	69 (68%)
Cause of cirrhosis
HBV	24 (23%)
HCV	17 (17%)
Alcohol	39 (38%)
PBC/PSC	7 (7%)
Unknown	15 (15%)
Cause of admission
Tense ascites	37 (36%)
Encephalopathy	17 (17%)
Variceal bleeding	16 (16%)
Jaundice	5 (5%)
Fever	11 (11%)
Other	16 (16%)
SBP on admission	9 (9%)
First sign of decompensation
Ascites	66 (65%)
Variceal bleeding	30 (29%)
Encephalopathy	5 (5%)
Jaundice	1 (1%)
Hematocrit (%)	33 (17-48)
Hemoglobin (g/dL)	11 (5-16)
White blood count (×109/L)	5.7 (1.2-23.9)
Platelet count (×109/L)	105 (19-394)
Prothrombin time (s)	16 (11-35)
INR	1.3 (0.9-3.3)
Creatinine (mg/dL)	1.1 (0.5-3.7)
Bilirubin (mg/dL)	2.6 (0.3-33.9)
AST (IU/L)	72 (20-610)
ALT (IU/L)	44 (11-433)
Alkaline phosphatase (U/L)	101 (42-487)
GGT (U/L)	70 (10-1 165)
Albumin (g/dL)	3.2 (1.9-4.3)
Child class
A	13 (13%)
B	42 (41%)
C	47 (46%)
Child-Pugh score	9 (5-15)
Modified Child-Pugh score-I	10 (5-19)
Modified Child-Pugh score-II	10 (5-17)
MELD score	12 (-10-45)

HBV: hepatitis B virus, HCV: hepatitis C virus, PBC: primary biliary cirrhosis, PSC: primary sclerosing cholangitis, SBP: spontaneous bacterial peritonitis, INR: international normalized ratio, AST: aspartate aminotransferase, ALT: alanine aminotransferase, GGT: gamma-glutamyl-transpeptidase, MELD: Model for End-stage Liver Disease. All quantitative variables are expressed as median values (range).

Table 2 Comparisons of the areas under the ROC curve of Child-Pugh, modified Child-Pugh-I, modified Child-Pugh-II and MELD scores for 3-, 6-, 12-, and 24-mo survival.

Survival (mo)	Predictive scores	Area under ROC	P (χ2)
3	Child-Pugh	0.73	0.19
	Modified Child-Pugh-I	0.76	0.58
	Modified Child-Pugh-II	0.78	0.73
	MELD	0.79
6	Child-Pugh	0.71	0.18
	Modified Child-Pugh-I	0.73	0.49
	Modified Child-Pugh-II	0.76	0.85
	MELD	0.77
12	Child-Pugh	0.68	0.09
	Modified Child-Pugh-I	0.73	0.38
	Modified Child-Pugh-II	0.74	0.51
	MELD	0.78
24	Child-Pugh	0.7	0.27
	Modified Child-Pugh-I	0.75	0.48
	Modified Child-Pugh-II	0.76	0.64
	MELD	0.79

P for comparison with MELD score.

Table 3 Association of baseline characteristics with survival in 102 patients with decompensated cirrhosis (results from univariate Cox proportional hazards models).

Patient characteristic	Hazard ratio	95%CI	P
Age (per yr)	0.99	0.90-1.03	0.72
Sex (male)	0.68	0.27-1.72	0.92
Cause of cirrhosis (unknown)
HBV	0.41	0.12-1.58	0.21
HCV	1.21	0.35-4.17	0.77
Alcohol	0.72	0.27-1.93	0.51
PBC/PSC	0.97	0.47-3.85	0.68
SBP on admission	4.25	1.41-12.84	0.01
White blood count (×109/L)	1.12	0.43-3.68	0.90
Platelet count (×109/L)	1.06	0.52-2.15	0.87
Prothrombin time (s)	2.48	0.50-12.19	0.26
INR	4.22	0.98-18.19	0.052
Creatinine (mg/dL)	4.62	1.76-12.13	0.012
Bilirubin (mg/dL)	2.25	1.5-3.38	<0.001
AST (IU/L)	1.95	1.12-3.4	0.018
ALT (IU/L)	1.70	1.03-2.8	0.039
Alkaline phosphatase (U/L)	0.83	0.38-1.86	0.66
GGT (U/L)	1.64	1.09-2.46	0.019
Albumin (g/dL)	0.53	0.07-3.84	0.53
Child class (A)
B	2.11	0.46-9.77	0.34
C	3.71	0.78-17.61	0.1

CI: confidence interval, HBV: hepatitis B virus, HCV: hepatitis C virus, PBC: primary biliary cirrhosis, PSC: primary sclerosing cholangitis, SBP: spontaneous bacterial peritonitis, INR: international normalized ratio, AST: aspartate aminotransferase, ALT: alanine aminotransferase, GGT: gamma-glutamyl-transpeptidase, MELD: Model for End-stage Liver Disease. Hazard ratios (95%CI) for quantitative variables are expressed for 1 relevant unit increase of loge.

Table 4 Crude and adjusted for GGT hazard ratio (HR) of death and 95%CI for the four scoring systems.

Scoring system	Unadjusted		Adjusted
	HR (95%CI)	c-statisticsHR	(95%CI)	c-statistics
Child-Pugh score	1.23 (1.04-1.45)	0.65	1.38 (1.14-1.68)	0.77
Modified Child-Pugh-I score	1.21 (1.09-1.36)	0.69	1.30 (1.13-1.50)	0.79
Modified Child-Pugh-II score	1.30 (1.13-1.48)	0.70	1.38 (1.18-1.62)	0.78
MELD score	1.11 (1.06-1.15)	0.73	1.10 (1.06-1.15)	0.81

MELD: Model for End-stage Liver Disease. HR (95%CI) are expressed for 1 unit increase.