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Liver Severity Score-Based Modeling to Predict Six-Week Mortality Risk Among Hospitalized Cirrhosis Patients With
Rochelle Wong1, Adam Buckholz2, Kaveh Hajifathalian3
1Department of Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
Insights
Child-Turcotte-Pugh (CTP) and Model-for-End-Stage-Liver Disease (MELD) scores accurately predict mortality in cirrhosis patients with upper gastrointestinal bleeding (UGIB). CTP class effectively stratifies risk before endoscopy.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Risk Stratification
Background:
- Gastrointestinal bleeding in cirrhosis patients carries high mortality.
- Current risk calculators' accuracy for all acute upper gastrointestinal bleeding (UGIB) types, especially non-portal hypertensive, needs further validation.
Purpose of the Study:
- To evaluate the accuracy of Child-Turcotte-Pugh (CTP) and Model-for-End-Stage-Liver Disease (MELD) scores in predicting short-term mortality for all UGIB etiologies in cirrhosis patients.
- To enable earlier risk stratification and targeted interventions for UGIB.
Main Methods:
- A large US single-center cohort study.
- Investigated and recalibrated CTP and MELD scores to predict six-week mortality.
- Analyzed both portal hypertensive and non-portal hypertensive UGIB sources.
Main Results:
- Both CTP and MELD models demonstrated excellent discrimination for predicting six-week mortality across all UGIB types.
- A CTP-based model showed superior calibration for all bleeding etiologies.
- Median predicted 6-week mortality risk for CTP classes A, B, and C was 1%, 7%, and 35%, respectively.
Conclusions:
- CTP and MELD scores possess similar discriminative abilities for predicting mortality in cirrhosis patients with UGIB.
- CTP class serves as an effective pre-endoscopy clinical decision tool for risk stratification (low, moderate, severe) in patients with cirrhosis and UGIB.
Background:
Patients with cirrhosis who have gastrointestinal bleeding have high short-term mortality, but the best modality for risk calculation remains in debate. Liver severity indices, such as Child-Turcotte-Pugh (CTP) and Model-for-End-Stage-Liver Disease (MELD) score, are well-studied in portal hypertensive bleeding, but there is a paucity of data confirming their accuracy in non-portal hypertensive bleeding and overall acute upper gastrointestinal bleeding (UGIB), unrelated to portal hypertension.
Aims:
This study aims to better understand the accuracy of current mortality risk calculators in predicting mortality for patients with any type of UGIB, which could allow for earlier risk stratification and targeted intervention prior to endoscopy to identify the bleeding source.
Methods:
In a large US single-center cohort, we investigated and recalibrated the model performance of CTP and MELD scores to predict six-week mortality risk for both sources of UGIB (portal hypertensive and non-portal hypertensive).
Results:
Both CTP- and MELD-based models have excellent discrimination in predicting six-week mortality for all types of bleeding sources. However, only a CTP-based model demonstrates calibration for all bleeding, regardless of bleeding etiology. Median predicted 6-week mortality by CTP class A, B, and C estimates a risk of 1%, 7%, and 35% respectively.
Conclusions:
Our study corroborates findings in the literature that CTP- and MELD-based models have similar discriminative abilities for predicting 6-week mortality in hospitalized cirrhosis patients presenting with either portal hypertensive or non-portal hypertensive UGIB. CTP class is an effective clinical decision tool that can be used, even prior to endoscopy, to accurately risk stratify a patient with known cirrhosis presenting with any UGIB into low, moderate, and severe risk groupings.
