Poster Presentations

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. Buroughs^2
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. *costaszisimo@hotmail.com

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.