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Does adding variceal status to the Child-Turcotte-Pugh score improve its performance in predicting mortality in
Xiaoli Fan1, Maoyao Wen, Yi Shen
1Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Insights
The Child-Turcotte-Pugh-Kumar (CTPK) score reliably predicts mortality in Chinese cirrhotic patients. However, the classical Child-Turcotte-Pugh (CTP) score demonstrated similar predictive accuracy for clinical outcomes.
Area of Science:
- Hepatology
- Clinical Medicine
- Prognostic Biomarkers
Background:
- The Child-Turcotte-Pugh (CTP) score is a standard tool for assessing liver disease severity and predicting outcomes in cirrhosis.
- Portal hypertension and esophageal variceal bleeding are major causes of mortality in cirrhosis but are not included in the CTP score.
Purpose of the Study:
- To evaluate if incorporating variceal status into the Child-Turcotte-Pugh-Kumar (CTPK) score improves the prediction of clinical outcomes in cirrhotic patients compared to the CTP score.
- To assess the prognostic utility of the CTPK score in a high-volume Chinese center.
Main Methods:
- Retrospective analysis of 253 cirrhotic patients admitted between January 1, 2014, and December 31, 2014.
- Calculation of CTP and CTPK scores upon admission, with follow-up for at least 12 months to assess survival.
- Multivariate Cox proportional hazards models and receiver operating characteristic (ROC) curve analysis (AUC-ROC) to evaluate predictive performance.
Main Results:
- The CTPK score was independently associated with 3- and 12-month mortality.
- Area under the ROC curves (AUC-ROC) at 3 months were 0.814 for CTPK and 0.838 for CTP; at 12 months, they were 0.825 for CTPK and 0.840 for CTP, with no significant difference.
- Kaplan-Meier analysis confirmed the prognostic value of the CTPK score in discriminating intermediate-term outcomes (P < 0.001).
Conclusions:
- The CTPK score offers reliable short- and medium-term mortality prediction in Chinese cirrhotic patients.
- The CTPK score did not demonstrate superior predictive ability compared to the classical CTP score.
- The CTP score remains a valuable tool for predicting outcomes in cirrhosis, highlighting the importance of considering variceal status.
Abstract:
The Child-Turcotte-Pugh (CTP) score is widely used worldwide to predict outcomes across a broad spectrum of liver diseases, mainly cirrhosis. Portal hypertension and variceal bleed are significant causes of morbidity and mortality in cirrhotic patients, although the variceal status is not incorporated into the classical CTP score. We sought to determine whether the inclusion of variceal status, specifically the Child-Turcotte-Pugh-Kumar (CTPK) score, would improve the utility of the classical CTP score to predict the clinical outcomes of cirrhotic patients in a single but high-volume center in China.We retrospectively analyzed the records of 253 patients from January 1, 2014 to December 31, 2014 and performed follow-up for at least 12 months. The CTPK score and the CTP score were obtained as soon as possible after the patient's admission. Telephone follow-up was performed to assess survival situations.At 3 and 12 months, the cumulative number of deaths was 9.1% (n = 23) and 13.8% (n = 35), respectively. In the multivariate Cox proportional hazards models, the CTPK score was independently associated with death within 3 and 12 months after adjusting for potential confounders. The predictive ability related to the 2 scores was evaluated by the area under the receiver operating characteristic curve (AUC-ROC) respectively. At 3 months of enrollment, the AUCs of CTPK and CTP were 0.814 and 0.838, respectively. At 12 months of enrollment, the AUCs of CTPK and CTP were 0.825 and 0.840, respectively. No significant difference between time points was observed. Both the CTPK score and the CTP score displayed prognostic value in cirrhotic patients, as the Kaplan-Meier analysis showed that the CTPK score could clearly discriminate patients in the intermediate term (P < 0.001).The CTPK score provides reliable prediction of mortality in Chinese cirrhotic patients for both short-term and medium-term prognoses, although it is not superior to the CTP score. Therefore, the CTP score remains an excellent tool for outcome prediction in patients with cirrhosis, and greater attention to variceal status may be in veins, even for patients with a history of variceal bleed or medium/large varices.
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