Usefulness of ΔMELD/month for Prediction of the Mortality in the First Episode of Variceal Bleeding Patients with Liver Cirrhosis: Comparison with CTP, MELD score and ΔCTP/month

Korean J Hepatol > Volume 13(1); 2007 > Article

The Korean Journal of Hepatology 2007;13(1): 51-60.

Usefulness of ΔMELD/month for Prediction of the Mortality in the First Episode of Variceal Bleeding Patients with Liver Cirrhosis: Comparison with CTP, MELD score and ΔCTP/month

Won Ki Bae, M.D., June Sung Lee, M.D., Nam Hoon Kim, M.D., Kyung Ah Kim, M.D., Young Soo Moon, M.D., Min Kyung Oh, Ph.D.1

Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea; 1Regional Clinical Trial Center, Pusan Paik Hospital, Pusan, Korea

ABSTRACT

Background/Aims
There are many models for predicting prognosis of liver cirrhosis including Child Turcotte Pugh (CTP), the model for end-stage liver disease (MELD) score and its changes over time (ΔCTP and ΔMELD/month). We investigated the ability of these models to predict the mortality of liver cirrhosis patients with the first episode of variceal bleeding and which model can be usefully applied in practice.
Methods
Seventy-one liver cirrhosis patients hospitalized for the first episode of esophageal variceal bleeding were retrospectively analyzed. The predictive power of initial CTP, MELD score, ΔCTP and ΔMELD/month was compared through c-statistics and multiple logistic regression. Results: All of the prognostic predictors measured higher in patients who survived than in those who died. The area under the receiver operating characteristic (ROC) curve for ΔMELD/month in 6 months was 1, a higher value than 0.81 for initial CTP, 0.75 for initial MELD, and 0.84 for ΔCTP/month; the area of ΔMELD/month in 12 months was 0.81, also showing a higher value than others. ΔMELD/month > 0.27 was a strong significant prognostic predictor in 6 (odds ratio: 40.1, p=0.001) and 12 months (odds ratio: 14.1, p<0.001). Only the ΔMELD/month was an independent prognostic predictor with a risk ratio of 1.604 (95% CI: 1.119-2.302, p=0.01) in 6 months and 1.627 (95% CI: 1.294-2.047, p<0.001) in 12 months. Conclusions: The ΔMELD/month is superior to initial CTP, MELD and ΔCTP/month to predict 6 and 12 months mortality in liver cirrhosis patients with the first episode of variceal bleeding. (Korean J Hepatol 2007;13:51-60)

KeyWords: Variceal bleeding; Fatal outcome; CTP; MELD; ΔCTP/month; ΔMELD/month