Indeed, patients with decompensated cirrhosis who are potential OLT candidates should enter into the transplant waiting lists neither too early nor too late, since early OLTs take away livers from candidates who are very sick and with more urgent indications and late OLTs are associated with worse outcomes. The need for improvement in the accuracy of prognosis in this setting has increased in the current era of the expansion of orthotopic liver transplantation (OLT) and the parallel increasing discrepancy between the numbers of OLT candidates and the numbers of available donor livers. The poor survival of patients with decompensated cirrhosis has driven physicians to a constant search for good prognostic markers. Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis.ĬONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice. Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. RESULTS: The areas under the receiver operating charac-teristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas: 0.71-0.79). Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated. METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied. We compared the predictive values of MELD, Child-Pugh and creatinine-modified Child-Pugh scores in decompensated cirrhosis. AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated.
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