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Prognostic value of Child-Turcotte criteria in medically treated cirrhosis
Insights
The Child-Turcotte criteria (CTC) effectively predict survival in cirrhosis patients without surgery. Higher CTC scores correlate with decreased survival and increased mortality risk from liver failure and cancer.
Area of Science:
- Hepatology
- Clinical Prognostics
- Medical Statistics
Background:
- The Child-Turcotte criteria (CTC) are established prognostic factors for cirrhotic patients undergoing portacaval shunt surgery.
- The prognostic value of CTC in conservatively managed cirrhosis patients remains less understood.
Purpose of the Study:
- To evaluate the prognostic significance of the Child-Turcotte criteria (CTC) in patients with histologically verified cirrhosis receiving conservative treatment.
- To assess the correlation between CTC scores and survival rates, as well as causes of mortality.
Main Methods:
- A cohort of 245 patients with confirmed cirrhosis from a clinical trial control group were analyzed.
- Patients were classified according to CTC criteria at trial entry.
- Survival curves were generated, and survival rates were compared using the log-rank test over a 16-year period.
Main Results:
- Survival significantly decreased with increasing abnormality in albumin, ascites, bilirubin, and nutritional status (p < 0.001 for albumin and ascites).
- Neurological status did not significantly influence survival (p = 0.11), likely due to the absence of hepatic coma at baseline.
- Increasing CTC scores correlated with reduced median survival (6.4 years for score 5 to 2 months for score ≥12) and increased mortality from hepatic failure, GI bleeding, and hepatocellular carcinoma.
Conclusions:
- The Child-Turcotte criteria provide valuable and accessible prognostic information for conservatively treated cirrhosis patients.
- While useful, CTC are less effective than a multivariate analysis-based prognostic index for predicting outcomes in this patient group.
Abstract:
The Child- Turcotte criteria (CTC) (based on serum bilirubin and albumin, ascites, neurological disorder and nutrition) are established prognostic factors in patients with cirrhosis having portacaval shunt surgery. The objective of this study was to evaluate the prognostic value of CTC in conservatively treated cirrhosis. Patients (n = 245) with histologically verified cirrhosis from a control group of a controlled clinical trial were studied. Data at entry into the trial were used to classify patients according to CTC. Survival curves for up to 16 years were made, and survival rates were compared using the log-rank test. Survival decreased significantly with increasing degree of abnormality (A----B----C) of albumin (p less than 0.001), ascites (p less than 0.001), bilirubin (p = 0.02) and nutritional status (p = 0.03). Survival was insignificantly influenced by neurological status (p = 0.11) probably because none of the patients had hepatic coma at entry into the trial. The five variables in CTC were combined to a score. With increasing score, the median survival time decreased from 6.4 years (score 5) to 2 months (scores 12 or more). Furthermore, the mortality from hepatic failure, gastrointestinal bleeding or hepatocellular carcinoma increased significantly with increasing score. CTC provide valuable and easily obtainable prognostic information in cirrhosis. However, CTC are inferior to a prognostic index based on multivariate analysis of prognostic factors.
