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Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis.
Liver Transpl. 2006 Jan; 12(1):65-71.LT

Abstract

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.

Authors+Show Affiliations

National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China. 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

16382473

Citation

Huo, Teh-Ia, et al. "Proposal of a Modified Child-Turcotte-Pugh Scoring System and Comparison With the Model for End-stage Liver Disease for Outcome Prediction in Patients With Cirrhosis." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 12, no. 1, 2006, pp. 65-71.
Huo TI, Lin HC, Wu JC, et al. Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis. Liver Transpl. 2006;12(1):65-71.
Huo, T. I., Lin, H. C., Wu, J. C., Lee, F. Y., Hou, M. C., Lee, P. C., Chang, F. Y., & Lee, S. D. (2006). Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 12(1), 65-71.
Huo TI, et al. Proposal of a Modified Child-Turcotte-Pugh Scoring System and Comparison With the Model for End-stage Liver Disease for Outcome Prediction in Patients With Cirrhosis. Liver Transpl. 2006;12(1):65-71. PubMed PMID: 16382473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis. AU - Huo,Teh-Ia, AU - Lin,Han-Chieh, AU - Wu,Jaw-Ching, AU - Lee,Fa-Yauh, AU - Hou,Ming-Chih, AU - Lee,Pui-Ching, AU - Chang,Full-Young, AU - Lee,Shou-Dong, PY - 2005/12/31/pubmed PY - 2006/6/10/medline PY - 2005/12/31/entrez SP - 65 EP - 71 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 12 IS - 1 N2 - The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/16382473/Proposal_of_a_modified_Child_Turcotte_Pugh_scoring_system_and_comparison_with_the_model_for_end_stage_liver_disease_for_outcome_prediction_in_patients_with_cirrhosis_ L2 - https://doi.org/10.1002/lt.20560 DB - PRIME DP - Unbound Medicine ER -