Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

Area of Science:

• Hepatology
• Internal Medicine
• Medical Statistics

Background:

• Decompensated liver cirrhosis poses a significant mortality risk.
• Accurate prediction of mortality is crucial for patient management.
• Several scoring systems exist, but their comparative accuracy needs evaluation.

Purpose of the Study:

• To compare the predictive accuracy of Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), MELD-Na, and MELD to Serum Sodium ratio (MESO) scores for mortality in decompensated liver cirrhosis.
• To assess the performance of these scores at different time points and in specific subgroups, such as cirrhotic patients with bleeding.

Main Methods:

• Systematic literature search of multiple databases (PubMed, Web of Science, Cochrane Library, EMBASE, Ovid) up to September 2018.
• Inclusion of 16 studies with a total of 2337 patients.
• Statistical analysis of scoring system accuracy using Stata 12 and MetaDiSc 1.4, focusing on Areas Under the Receiver Operating Characteristic Curves (AUROCs).

Main Results:

• The MELD to Serum Sodium ratio (MESO) demonstrated the highest pooled AUROC (0.86) for predicting mortality across all assessed scoring systems.
• MELD-Na showed strong predictive accuracy, particularly at 3 months (AUROC 0.89).
• The Model for End-stage Liver Disease (MELD) score (AUROC 0.88) outperformed the Child-Turcotte-Pugh (CTP) score (AUROC 0.76) in predicting variceal bleeding in cirrhotic patients.

Conclusions:

• The MELD to Serum Sodium ratio (MESO) is the most accurate scoring system for predicting mortality in decompensated liver cirrhosis.
• MELD-Na offers good accuracy for mortality prediction at various time points.
• The MELD score provides superior prediction of variceal bleeding compared to the CTP score.