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Comparison Between Creatinine-Modified Pugh Score and Child-Pugh Score for Prognostication in Decompensated Cirrhosis
Suraj Kumar1, Shobhit Shah1, Balvir Singh2
1Cardiology, King George's Medical University, Lucknow, IND.
Insights
Adding blood creatinine to the Child-Pugh score improves liver cirrhosis prognosis. This modified score accurately predicts survival and complications, especially in patients with moderate to severe hepatic encephalopathy.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Prognostics
Background:
- The Child-Pugh (CP) score is a standard prognostic tool for liver cirrhosis.
- Blood creatinine levels are increasingly recognized as significant predictors of survival in cirrhosis patients.
Purpose of the Study:
- To compare the prognostic accuracy of the traditional CP score and a modified CP score incorporating serum creatinine.
- To evaluate the predictive power of these scores in decompensated cirrhosis patients.
Main Methods:
- A prospective study involving 100 decompensated cirrhosis patients.
- Calculation of traditional CP scores (range 5-15) and modified CP scores (range 5-19) using admission data, with serum creatinine as an added variable.
- Analysis of patient demographics, including age, sex, and hepatic encephalopathy severity.
Main Results:
- The modified CP score demonstrated a high predictive accuracy (AUC=0.852) in patients with moderate to severe hepatic encephalopathy.
- Demographic data included a mean age of 44.71 years, with 74% males and 26% females.
- Hepatic encephalopathy distribution was 52% mild, 24% moderate, and 24% severe.
Conclusions:
- Incorporating serum creatinine into the Child-Pugh score enhances its prognostic utility for liver cirrhosis.
- Serum creatinine is crucial for accurately predicting survival and complications, particularly in patients with moderate to severe hepatic encephalopathy.
Abstract:
Introduction, aim, and objective: Despite recent evidence suggesting the blood creatinine level is a significant predictor of survival in liver cirrhosis patients, the conventional Child-Pugh (CP) score has held a longstanding position as a valuable prognostic indicator in cirrhotic individuals. This study aimed to compare the predictive capabilities of the modified CP score and the traditional CP score in decompensated cirrhosis patients to evaluate their prognostic power. The objective of this study was to assess the prognostic value of the modified and traditional CP scores in individuals with decompensated cirrhosis by assessing their predictive accuracy.
Methods:
A total of 100 patients diagnosed with decompensated cirrhosis participated in this prospective study. Each patient's Child-Pugh score and class were determined using admission data, with scores ranging from 5 to 15. Serum creatinine was incorporated as the sixth variable to compute the modified CP score, which ranges from 5 to 19.
Results:
The percentages of individuals aged 16-30, 31-40, 41-50, 51-60, and above 60 years were as follows: 16.0%, 29.0%, 26.0%, and 11.0%, respectively. The patients had a mean age of 44.71 years and a standard deviation of 13.40 years. Out of the 100 patients studied, 26% were female and 74% were male. Fifty-two percent of patients had mild hepatic encephalopathy, while 24% had moderate encephalopathy and 24% had severe encephalopathy. In cases of moderate and severe hepatic encephalopathy, the creatinine-modified Pugh score showed a considerably large area under the curve (AUC=0.852) on the receiver operating characteristics (ROC) curve.
Conclusion:
When blood creatinine is taken into account, it can enhance the Child-Pugh classification's prognostic usefulness. This is especially true for patients with moderate to severe hepatic encephalopathy, where serum creatinine is a key factor in accurately predicting both survival and complications associated with cirrhosis.
