Clinical Usefulness of ΔMELD to Predict the Survival of Patients with Liver Cirrhosis

Korean J Hepatol > Volume 12(4); 2006 > Article

The Korean Journal of Hepatology 2006;12(4): 530-538.

Clinical Usefulness of ΔMELD to Predict the Survival of Patients with Liver Cirrhosis

Soo Hoon Eun, M.D., Yun Soo Kim, M.D.1, Jae Young Jang, M.D., Young Gook Cheon, M.D., Young Seok Kim, M.D., Young Deok Cho, M.D., Joon Sung Lee, M.D., Moon Sung Lee, M.D., Ju Hyun Kim, M.D.1, Chan Sup Shim, M.D., and Boo Sung Kim, M.D.

Institute for Digestive Research, Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul; Department of Gastroenterology and Hepatology, Gil Medical Center, Gachon University1, Incheon, Korea

ABSTRACT

Backgrounds
/Aims: The change of MELD (Model for End-stage Liver Disease) score over time (ΔMELD) has been proposed as a tool to predict the survival in cirrhotic patients. The aims of the study were to assess ability of the ΔMELD to predict the survival and compare them with the initial MELD and CP score. Methods: MELD score was serially determined at least twice with more than two-month interval in 120 cirrhotic patients. We analyzed the clinical factors associated with the variation of MELD score. The predictive power of 6, 12 and 24 months mortality for ΔMELD, initial MELD and CP score was compared by c-statistics. Patient survival was also compared at 6, 12 and 24 months according to the cut off values of ΔMELD/month, initial MELD and CP score. Results: Increased MELD score was associated with biochemical and clinical parameters such as esophageal variceal bleeding and onset of hepatic encephalopathy. The area under receiver operating characteristic (ROC) curve for ΔMELD/month was 0.928 (P<0.001) compared with 0.575 for MELD score and 0.636 for CP score at 6 month-mortality; the area was 0.727, 0.594 and 0.657 at 12 month-mortality; 0.693, 0.587 and 0.639 at 24 month-mortality, respectively. The patients with ΔMELD/month more than 1.0 had resulted in the higher mortality at 6, 12 and 24 months. The ΔMELD/month was associated with mortality and was an independent prognostic predictor with a risk ratio of 1.679 (95% CI: 1.381-2.042, P<0.001). Conclusions: Determination of ΔMELD could be better prognostic predictor for patients with liver cirrhosis than initial MELD and CP score. (Korean J Hepatol 2006;12:530-538)

KeyWords: Liver cirrhosis; Survival; Child-Pugh score; MELD score; Prognosis; ΔMELD