Comparison of the abilities of five scoring systems to predict short-term and medium-term death risks in patients with decompensated cirrhosis

Objective To compare the abilities of Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) , MELD combined with serum sodium concentration (MELD-Na) , integrated MELD (iMELD) , and MELD to SNa ratio (MESO) to predict short-term and medium-term death risks in patients with decompensated cirrhosis at months 3 and 12.Methods The records of 269 patients with decompensated cirrhosis in Department of Gastroenterology, West China Hospital, Sichuan University from January 1 to December31, 2014 were retrospectively analyzed.The CTP, MELD, MELD-Na, iMELD, and MESO scores were evaluated for these patients within48 hours after admission and these patients were followed up for at least 12 months.The predictive abilities of these five scoring systems were evaluated by the area under the receiver operating characteristic curve (AUC) at months 3 and 12.Comparison of continuous data was conducted using t test (for data with normal distribution and homogeneity of variance) or Mann-Whitney U test (for data with non-normal distribution) , while comparison of categorical data was conducted using χ2 test.Meanwhile, logistic regression analysis, Hosmer-Lemeshow goodness-of-fit test, and Kaplan-Meier survival analysis were performed.Results Twenty-five (9.29%) and thirty-eight (14.13%) of all patients died within 3 months and 12 months, respectively.There were significant differences between the patients who died and survived within 12 months in total bilirubin, creatinine, urea, albumin, white blood cell count, prothrombin time, international normalized ratio, serum sodium, the presence or absence of hepatic encephalopathy on admission, degree of ascites, the CTP, MELD, MELD-Na, iMELD, and MESO scores on admission, history of hepatic encephalopathy, and treatments for these factors after discharge (all P<0.05) .The multivariate logistic regression analysis revealed that all five scores were independent prognostic factors for the patients (odds ratios:CTP=2.020, MELD=1.252, MELD-Na=1.088, iMELD=1.114, MESO=1.368;all P<0.01) .At month 3, CTP score had the highest AUC (0.823) , followed by MESO (0.796) , MELD (0.789) , MELD-Na (0.775) , and iMELD (0.770) scores.At month 12, the AUC values for CTP, MELD, MELD-Na, iMELD, and MESO were 0.834, 0.798, 0777, 0.801, and 0.804, respectively.Therefore, CTP score was best in predicting the death risks within 3 and 12 months.The Kaplan-Meier curves showed that these five scoring methods clearly distinguished 12-month cumulative survival rates for these patients (all P<0.05) .Conclusion CTP score, MELD score, and three MELD-related scores can reliably predict both short-term and medium-term death risks in patients with decompensated cirrhosis.Moreover, CTP score may have a better ability to predict death risks in patients with decompensated cirrhosis in China.