Applicability of MELD as a short-term prognostic indicator in patients with chronic liver disease: an Indian experience
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Peeyush Mishra1, Nutan Desai, Jacob Alexander
1Department of Gastroenterology, Lokmanya Tilak Municipal Medical College, Mumbai, India.
Background:
The model for end-stage liver disease (MELD), which employs objective variables, statistical weighting and a continuous scale, has replaced the Child-Turcotte-Pugh (CTP) classification as the scoring system of choice in several liver transplant centers. However, the predictive ability of MELD has never been prospectively evaluated in India. The aim of this study was to examine the MELD score, the CTP score and the recently proposed modified CTP score in Indian patients with liver cirrhosis to determine their correlation and compare their prognostic significance for short-term survival.
Methods:
A total of 76 patients with cirrhosis (mean age 46.97 years) were prospectively evaluated and followed up for 6 months. MELD score, CTP score and modified CTP score were calculated at baseline. The correlation between variables was evaluated by Pearson's correlation test. 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:
Alcoholic liver disease was the most common (50%) etiology of cirrhosis. MELD score and CTP score showed very good correlation (Pearson correlation r = 0.983). ROC curve showed area under curve (c-statistics) for MELD score, CTP score and modified CTP score as 0.764, 0.804 and 0.817, respectively.
Conclusion:
The MELD score was not found to be superior to CTP score and modified CTP score for short-term prognostication of patients with cirrhosis in this study.
Insights
The Model for End-Stage Liver Disease (MELD) score did not outperform the Child-Turcotte-Pugh (CTP) score or modified CTP score in predicting short-term survival for Indian cirrhosis patients.
Area of Science:
- Hepatology
- Clinical Prognostication
- Liver Transplantation
Background:
- The Model for End-Stage Liver Disease (MELD) score is increasingly used for liver transplant allocation.
- Its predictive accuracy in the Indian population for cirrhosis prognostication remains unevaluated.
- This study addresses the need for prospective validation of MELD and other scores in India.
Purpose of the Study:
- To compare the prognostic significance of MELD, CTP, and modified CTP scores for short-term survival in Indian cirrhosis patients.
- To evaluate the correlation between these scoring systems.
- To determine the predictive accuracy of each score in this specific demographic.
Main Methods:
- Prospective evaluation of 76 cirrhosis patients over 6 months.
- Baseline calculation of MELD, CTP, and modified CTP scores.
- Pearson correlation for variable assessment and ROC curves for discriminating survival.
Main Results:
- Alcoholic liver disease was the most common etiology (50%).
- MELD and CTP scores demonstrated a strong correlation (r=0.983).
- Areas under the ROC curve were 0.764 (MELD), 0.804 (CTP), and 0.817 (modified CTP).
Conclusions:
- MELD score was not superior to CTP or modified CTP scores for short-term prognostication in this Indian cohort.
- Modified CTP score showed the highest discriminative ability in this study.
- Further research may be needed to refine prognostic models for Indian liver cirrhosis patients.
