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KMID : 1103920070130010051
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Korean Journal of Hepatology
2007 Volume.13 No. 1 p.51 ~ p.60
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Usefulness of ΔMELD/month for Prediction of the Mortality in the First Episode of Variceal Bleeding Patients with Liver Cirrhosis: Comparison with CTP, MELD score and ΔCTP/month
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Bae Won-Ki
Lee June-Sung
Kim Nam-Hoon
Kim Kyung-Ah
Moon Young-Soo
Oh Min-Kyung
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Abstract
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Background/Aims: There are many models for predicting prognosis of liver cirrhosis including Child Turcotte Pugh (CTP), the model for end-stage liver disease (MELD) score and its changes over time (ΔCTP and ΔMELD/month). We investigated the ability of these models to predict the mortality of liver cirrhosis patients with the first episode of variceal bleeding and which model can be usefully applied in practice.
Methods: Seventy-one liver cirrhosis patients hospitalized for the first episode of esophageal variceal bleeding
were retrospectively analyzed. The predictive power of initial CTP, MELD score, ΔCTP and ΔMELD/month was compared through c-statistics and multiple logistic regression.
Results: All of the prognostic predictors measured higher in patients who survived than in those who died. The area under the receiver operating characteristic (ROC) curve for ΔMELD/month in 6 months was 1, a higher value than 0.81 for initial CTP, 0.75 for initial MELD, and 0.84 for ΔCTP/month; the area of ΔMELD/month in 12 months was 0.81, also
showing a higher value than others. ΔMELD/month > 0.27 was a strong significant prognostic predictor in 6 (odds ratio: 40.1, p=0.001) and 12 months (odds ratio: 14.1, p<0.001). Only the ΔMELD/month was an independent prognostic predictor with a risk ratio of 1.604 (95% CI: 1.119-2.302, p=0.01) in 6 months and 1.627 (95% CI: 1.294-2.047, p<0.001) in 12 months.
Conclusions: The ΔMELD/month is superior to initial CTP, MELD and ΔCTP/month to predict 6 and 12 months mortality in liver cirrhosis patients with the first episode of variceal bleeding.
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KEYWORD
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Variceal bleeding, Fatal outcome, CTP, MELD, ΔCTP/month, ΔMELD/month
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