Validation of CTP, MELD & MELD Na Scoring Systems for Predicting Treatment Outcome of Cirrhotic patients in Bangladesh- An observational study

Author(s): Syeda Nur-E-Jannat, Dewan Saifuddin Ahmed

Background: Cirrhosis of liver is a very common medical problem. There is no satisfactory curative treatment option for end stage liver disease (ESLD) other than liver transplantation (LT). Due to scarcity of liver donors worldwide, a good prognostic model predicting highest risk of dying and to prepare a ‘priority list’ in waiting list candidates is essential for proper timing of LT to reduce mortality and improve success rate.

Objectives: The aim of this study was to evaluate the validity of Child-Turcotte-Pugh (CTP), MELD and MELD Na score for predicting treatment outcome (1 month, 3-month, 6-month mortality) of cirrhotic patients in Bangladesh.

Methods: This was an observational study conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from April 2012 to March 2014. Total 92 patients with cirrhosis (mean age 48.7±12.3 yrs) were prospectively evaluated and followed up for 6 months and outcome were assessed as 1 month, 3 month and 6 month mortality. CTP, MELD, MELD Na score were calculated at baseline. Receiver operating characteristic (ROC) curves were used to determine the cutoff values for each score with the best sensitivity and specificity in discriminating between patients who survived and those who died.

Results: Total 92 patients with liver cirrhosis were enrolled. The mean age of the patients was 48.7±12.3 yrs with a range of 18-68 yrs. ROC curve showed area under curve (c- statistics) for CTP, MELD and MELD Na score. For 1 month mortality cut off value of CTP, MELD, MELD Na score was 10.5, 20, 18 respectively with a sensitivity of 64.7%, 76.5%, 88.2% and specificity 93.3%, 90.7 %, 89.3 % respectively. For 3 month mortality cut off value of CTP, MELD, MELD Na score was 10.5, 19 and 18 with a sensitivity of 66.7% 77.8%, 88.9% and specificity of 93.9%, 93%, 93.7% respectively. For 6 month mortality cut off value of CTP, MELD, MELD Na score was 11.5, 18.5 and 18 with a sensitivity of 62.5%, 87.5%, 87.5% and specificity of 94.8%, 89.7%, and 92.6% respectively. MELD Na had the highest AUC in predicting 1 month, 3 month and 6 month mortality among all prognostic models.

Conclusions: CTP, MELD, MELD Na scores were good prognostic model to predict 1 month, 3 month and 6 month mortality. MELD Na was found to be the best predictor with highest AUC.

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