Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
MELD VS CPS FOR PROGNOSIS IN CIRRHOSIS. RESULTS FROM A MULTICENTRE STUDY
C. Triantos1, K. Zisimopoulos1*, E. Tsochatzis2, J. Vlachogiannakos3, S. Manolakopoulos4, C. Rigamonti2, J. Goulis5, E. Manesis4, J. Anastasiou3, F. Papalexi5, K. Georgiou6, A. Saveriadis3, K. Thomopoulos1, V. Margaritis1, D. Tzourmakliotis6, E. Akriviadis5, A. Archimandritis4, D. Karamanolis3, V. Nikolopoulou1, A.K. Buroughs2
1University Hospital of Patras, Patras, Greece, 2Royal Free Hospital, London, UK, 3Evangelismos General Hospital, 4Hippokration General Hospital of Athens, Athens, 5Hippocration General Hospital of Thessaloniki, Thessaloniki, 6Polyclinic General Hospital, Athens, Greece. *firstname.lastname@example.org
Background/aim: The Model for end-stage (MELD) liver disease is used for allocation of recipients waiting for liver transplantation and models 3 month mortality. However the prognostic accuracy in other settings for cirrhosis is not clear, but despite this MELD is being used as a global prognostic index in substitution for Child-Pugh score (CPS). We evaluated both CPS and MELD for longer term survival.
Patients/methods: Six referral centres for liver diseases: 1243 consecutive cirrhotics diagnosed on biopsy or imaging - 1014 analyzed (229 lost to follow up). Men/women: 653/361, age median: 60 years (18-92), follow up: 26 months (1-217), CP (A/B/C): 52/36/12 %, CPS: mean: 7, median: 6 (5-13), MELD: mean: 13, median: 12 (6-39) ; HBV=18 %, HCV= 14 %, alcohol=31 %, PBC=12 %, PSC=0.5 %, autoimmune= 2%, other: 22.5%. Individual components of CPS and MELD, as well CPS score, grade and MELD score were evaluated in different models. Cox regression was used to evaluate factors associated with survival.
Results: 106 patients died during follow up (32 within 1 year). In Cox multivariate analysis independent variables associated with survival were: age (HR: 1.04, 95% CI: 1.02-1.06; P< 0.001), and CPS (HR: 1.19, 95% CI: 1.01-1.4; P=0.031), or CP grade (HR=1.51; 95%CI 1.03-2.23 P=0.037), but MELD and sodium were not. At 1 year CP grade was significant (P=0.03) but not MELD.
Conclusions: Child Pugh score and grade are significant prognostic factors for medium and long term survival in cirrhosis. In this large cohort MELD was not independently predictive, and thus requires re-evaluation(and should not be used) as a prognostic model outside of transplant allocation settings.