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MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients
Wichit Srikureja1, Namgyal L Kyulo, Bruce A Runyon
1Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Background/Aims:
The aim of the present study was to compare MELD score, Child-Turcotte-Pugh (CTP) score, modified Maddrey's Discriminant Function (DF) score, and the related variables in predicting in-hospital mortality of patients with alcoholic hepatitis.
Methods:
A retrospective chart review and statistical analyses were done on 202 patients consecutively admitted for alcoholic hepatitis from 1997 to 2002 at the Liver Unit at Rancho Los Amigos Medical Center.
Results:
Twenty-nine patients died during the hospitalization. Admission MELD score (OR 1.1, P=0.005), first week MELD score (OR 1.2, P<0.0001), and first week increase in MELD score (OR 1.3, P<0.0001) were independently associated with in-hospital mortality. The area under the receiver operating curve (AUC) for the first week increase in MELD score was higher compared to CTP score (P=0.0004) and DF score (P=0.059). Moreover, the first week MELD score >/=20 had the best sensitivity (91%) and specificity (85%) compared with admission or first week change MELD score.
Conclusions:
The present study indicates that in patients with alcoholic hepatitis, admission, first week, and first week change in MELD score are significantly independent predictors for in-hospital mortality. MELD score is a more valuable model than CTP or DF score in patients admitted with alcoholic hepatitis.
Insights
The Model for End-Stage Liver Disease (MELD) score effectively predicts in-hospital mortality in alcoholic hepatitis patients. MELD scores, particularly changes within the first week, demonstrate superior predictive accuracy compared to Child-Turcotte-Pugh and Maddrey
Area of Science:
- Hepatology
- Internal Medicine
- Medical Statistics
Background:
- Alcoholic hepatitis is a severe liver condition with significant in-hospital mortality.
- Accurate prediction of mortality is crucial for timely intervention and patient management.
Purpose of the Study:
- To compare the predictive performance of MELD score, Child-Turcotte-Pugh (CTP) score, and Maddrey's Discriminant Function (DF) score for in-hospital mortality in alcoholic hepatitis patients.
Main Methods:
- Retrospective chart review of 202 patients admitted with alcoholic hepatitis.
- Statistical analysis to assess the association of MELD, CTP, and DF scores with in-hospital mortality.
Main Results:
- MELD score at admission, during the first week, and the first-week increase were all independently associated with in-hospital mortality.
- The first-week increase in MELD score showed a higher predictive accuracy (AUC) than CTP and DF scores.
- A first-week MELD score of ≥20 demonstrated the highest sensitivity (91%) and specificity (85%) for predicting mortality.
Conclusions:
- MELD score is a valuable and independent predictor of in-hospital mortality in patients with alcoholic hepatitis.
- MELD score outperforms CTP and DF scores in predicting outcomes for this patient population.
