Shaikh Samiullah, Ghani Hanif, Memon Sadik, Baloch Ghulam Hussain, Jaffery Mukhtiar, Shaikh Khalid
Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan.
J Coll Physicians Surg Pak. 2010 Jul;20(7):432-5.
To compare the predictive value of MELD (Model of end stage liver disease) and Child-Pugh (CP) scores in patients with decompensated cirrhosis of liver.
Descriptive study.
Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro/ Hyderabad, from August 2006 to October 2007.
This study included 110 consecutive patients with decompensated cirrhosis of liver diagnosed either clinically or radiologically were followed-up during hospital stay. Studied variables included demographic data, cirrhosis related complications and investigations. Patients were classified according to original CP classification into A, B and C. MELD score was estimated from serum bilirubin, serum creatinine and INR (International normalized ratio) of the patients. Duration of hospitalization and in-hospital mortality were made as the end points of the study. T-test and Chi-square test were done for continuous and categorical data. Original CP and MELD score were compared by the ROC curve. 0.05 was kept as the level of significance.
There were 110 patients with decompensated cirrhosis of liver. Mean age was 46.76+12.93 years. There were 72 (65%) male and 38 (35%) females patients. Hepatitis C was the most prevalent cause of cirrhosis of liver present in 60/110 (60%) cases. Ascites was present in 93/110 (83%) patients. The mean MELD scores were 2.23+0.712 (95% CI 2.09 - 2.36) and for CTP 2.52+0.586 (95%; CI 2.41-2.63). The outcome of the patients were 12 deaths (11%); 54 (49%) remained hospitalized for up to 14 days and 44 (40%) for > 14 days. The majority of deaths and prolong hospitalization were found in patients with MELD score > 15 as well as with Child-Pugh grade C. The c-statistic was 0.726 (p=0.001) for CP score, and 0.642 for MELD score (p=0.021).
The MELD score was not found to be superior to CTP score for short-term prognostication of patients with cirrhosis in this study.
比较终末期肝病模型（MELD）和Child-Pugh（CP）评分对失代偿期肝硬化患者的预测价值。
描述性研究。
2006年8月至2007年10月，在詹姆肖罗/海得拉巴的利亚卡特医科大学医学部。
本研究纳入110例经临床或影像学诊断为失代偿期肝硬化的连续患者，在住院期间进行随访。研究变量包括人口统计学数据、肝硬化相关并发症及检查。患者根据原始CP分级分为A、B、C级。根据患者的血清胆红素、血清肌酐和国际标准化比值（INR）估算MELD评分。将住院时间和院内死亡率作为研究终点。对连续数据和分类数据分别进行t检验和卡方检验。通过ROC曲线比较原始CP评分和MELD评分。显著性水平设定为0.05。
110例失代偿期肝硬化患者。平均年龄为46.76±12.93岁。男性72例（65%），女性38例（35%）。丙型肝炎是肝硬化最常见的病因，占60/110（60%）例。93/110（83%）患者出现腹水。MELD评分均值为2.23±0.712（95%CI 2.09 - 2.36），CTP评分为2.52±0.586（95%；CI 2.41 - 2.63）。患者结局为12例死亡（11%）；54例（49%）住院时间长达14天，44例（40%）住院时间>14天。大多数死亡和延长住院时间的情况见于MELD评分>15以及Child-Pugh C级的患者。CP评分的c统计量为0.726（p = 0.001），MELD评分为0.642（p = 0.021）。
在本研究中，MELD评分在肝硬化患者短期预后评估方面并不优于CTP评分。
