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Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score.
J Hepatol. 2005 Jun; 42(6):826-32.JH

Abstract

BACKGROUND/AIMS

The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. The change in MELD score over time (DeltaMELD) may have additional prognostic value. We investigated the ability of DeltaMELD to predict the outcome of advanced cirrhosis and prospectively assessed the factors associated with increasing DeltaMELD.

METHODS

Risk factors were determined in 58 prospectively followed-up patients. The predictive power of DeltaMELD, initial MELD and Child-Turcotte-Pugh (CTP) score was compared by using c-statistic in 351 patients.

RESULTS

Ascites (P=0.020) and hepatic encephalopathy (P=0.023) were significantly associated with increasing MELD score at 3 months. The area under receiver operating characteristic (ROC) curve for DeltaMELD/month was 0.779 compared with 0.718 for MELD (P=0.130) and 0.528 for CTP score (P<0.001) at 6 months; the area was 0.822, 0.744 and 0.528, respectively (P=0.018 and <0.001, respectively) at 12 months. DeltaMELD/month >2.5 was the only significant prognostic predictor at 6 (odds ratio: 9.8, P<0.001) and 12 months (odds ratio: 16.3, P<0.001) in multivariate logistic analysis.

CONCLUSIONS

Increasing MELD score is associated with the onset of ascites and encephalopathy. DeltaMELD is superior to initial MELD and CTP scores to predict intermediate term outcome in patients with advanced cirrhosis.

Authors+Show Affiliations

National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. tihuo@vghtpe.gov.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15885353

Citation

Huo, Teh-Ia, et al. "Evaluation of the Increase in Model for End-stage Liver Disease (DeltaMELD) Score Over Time as a Prognostic Predictor in Patients With Advanced Cirrhosis: Risk Factor Analysis and Comparison With Initial MELD and Child-Turcotte-Pugh Score." Journal of Hepatology, vol. 42, no. 6, 2005, pp. 826-32.
Huo TI, Wu JC, Lin HC, et al. Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol. 2005;42(6):826-32.
Huo, T. I., Wu, J. C., Lin, H. C., Lee, F. Y., Hou, M. C., Lee, P. C., Chang, F. Y., & Lee, S. D. (2005). Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. Journal of Hepatology, 42(6), 826-32.
Huo TI, et al. Evaluation of the Increase in Model for End-stage Liver Disease (DeltaMELD) Score Over Time as a Prognostic Predictor in Patients With Advanced Cirrhosis: Risk Factor Analysis and Comparison With Initial MELD and Child-Turcotte-Pugh Score. J Hepatol. 2005;42(6):826-32. PubMed PMID: 15885353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. AU - Huo,Teh-Ia, AU - Wu,Jaw-Ching, AU - Lin,Han-Chieh, AU - Lee,Fa-Yauh, AU - Hou,Ming-Chih, AU - Lee,Pui-Ching, AU - Chang,Full-Young, AU - Lee,Shou-Dong, Y1 - 2005/03/31/ PY - 2004/07/20/received PY - 2004/11/24/revised PY - 2005/01/15/accepted PY - 2005/5/12/pubmed PY - 2005/8/10/medline PY - 2005/5/12/entrez SP - 826 EP - 32 JF - Journal of hepatology JO - J Hepatol VL - 42 IS - 6 N2 - BACKGROUND/AIMS: The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. The change in MELD score over time (DeltaMELD) may have additional prognostic value. We investigated the ability of DeltaMELD to predict the outcome of advanced cirrhosis and prospectively assessed the factors associated with increasing DeltaMELD. METHODS: Risk factors were determined in 58 prospectively followed-up patients. The predictive power of DeltaMELD, initial MELD and Child-Turcotte-Pugh (CTP) score was compared by using c-statistic in 351 patients. RESULTS: Ascites (P=0.020) and hepatic encephalopathy (P=0.023) were significantly associated with increasing MELD score at 3 months. The area under receiver operating characteristic (ROC) curve for DeltaMELD/month was 0.779 compared with 0.718 for MELD (P=0.130) and 0.528 for CTP score (P<0.001) at 6 months; the area was 0.822, 0.744 and 0.528, respectively (P=0.018 and <0.001, respectively) at 12 months. DeltaMELD/month >2.5 was the only significant prognostic predictor at 6 (odds ratio: 9.8, P<0.001) and 12 months (odds ratio: 16.3, P<0.001) in multivariate logistic analysis. CONCLUSIONS: Increasing MELD score is associated with the onset of ascites and encephalopathy. DeltaMELD is superior to initial MELD and CTP scores to predict intermediate term outcome in patients with advanced cirrhosis. SN - 0168-8278 UR - https://www.unboundmedicine.com/medline/citation/15885353/Evaluation_of_the_increase_in_model_for_end_stage_liver_disease__DeltaMELD__score_over_time_as_a_prognostic_predictor_in_patients_with_advanced_cirrhosis:_risk_factor_analysis_and_comparison_with_initial_MELD_and_Child_Turcotte_Pugh_score_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(05)00178-9 DB - PRIME DP - Unbound Medicine ER -