Korean J Hepatol.  2007 Mar;13(1):51-60.

Usefulness of delta MELD/month for Prediction of the Mortality in the First Episode of Variceal Bleeding Patients with Liver Cirrhosis: Comparison with CTP, MELD score and delta CTP/month

• Bae WK
• Lee JS
• Kim NH
• Kim KA
• Moon YS
• Oh MK

Abstract

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 (delta CTP and delta MELD/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, delta CTP and delta MELD/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 delta MELD/month in 6 months was 1, a higher value than 0.81 for initial CTP, 0.75 for initial MELD, and 0.84 for delta CTP/month; the area of delta MELD/month in 12 months was 0.81, also showing a higher value than others. delta MELD/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 delta MELD/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 delta MELD/month is superior to initial CTP, MELD and delta CTP/month to predict 6 and 12 months mortality in liver cirrhosis patients with the first episode of variceal bleeding.

Keyword

Variceal bleeding; Fatal outcome; CTP; MELD; delta CTP/month; delta MELD/month

MeSH Terms

Adult
Aged
Esophageal and Gastric Varices/diagnosis/*mortality
Female
Gastrointestinal Hemorrhage/diagnosis/*mortality
Humans
Liver Cirrhosis/diagnosis/*mortality
Male
Middle Aged
Needs Assessment
Prognosis
ROC Curve
*Severity of Illness Index
Survival Analysis
Survival Rate
Time Factors