Child-Turcotte-Pugh and Model for End-Stage Liver Disease Scores: Accuracy of Predictability for Mortality in Acute Variceal Hemorrhage

Abstract

Objective: To determine a score that best predicts the mortality of admitted patients within six weeks of Acute Variceal Hemorrhage (AVH).
Study Design: Cross sectional study.
Place and Duration of Study: The study was conducted at Inpatient Department of Gastroenterology Unit at Pakistan Institute of Medical Sciences (PIMS), Islamabad for six months.
Materials and Methods: The number of patients with AVH enrolled in this study were 223. A pretested questionnaire was used to gather the required information; Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of each patient were recorded at the time of admission in the inpatient facility. The outcome was documented via a telephonic call at the end of six weeks. The primary outcome of the study was “mortality” at end of six weeks.
Results: The total number of participants were 223, including 61% (n=136) males and 39% (n=87) females. The mean age was 52.4±13.96. The overall mean value of CTP score was 9.6±2.8 and mean value of MELD score was 19.3±6.7, while the mean values of CTP and MELD among non-survivors were 12.9±2.1 and 26.6±5.6, respectively. After six weeks, the number of deaths were 27% (n=60). The MELD had positive predictive value (PPV) of 83.3%, negative predictive value (NPV) of 96.8%, sensitivity: 91.7%, specificity: 93.3%, diagnostic accuracy: 92.82%, and positive likelihood ratio of 13.68. Similarly, CTP had PPV: 77.4%, NPV: 92.5%, sensitivity: 80%, specificity: 91.4%, diagnostic accuracy: 88.34% and positive likelihood ratio of 9.3. The area under the curve (AUC)for MELD was 0.91, while CTP was 0.90.
Conclusion: The MELD score is better in its discriminative ability and more accurate in predicting six weeks mortality in patients with AVH than CTP score.