The Value of MELD Score and Serum Total Cholesterol in Predicting the Prognsis of Patients with Decompensated Liver Cirrhosis Caused by Hepatitis B Virus
|School||Anhui Medical University,|
|Keywords||Model for end-stage liver disease Serum total cholesterol Child-Turcotte-Pugh score Cirrhosis Hepatitis B virus|
BackgroundChina is the high incidence area for hepatitis B. It has been estimated that about 10% of Chinese are with positive hepatitis B surface antigen, 10%-20% of acute hepatitis B patients can develop chronic hepatitis B, cirrhosis, even hepatocellular carcinoma. The mortality rate of decompensated cirrhosis due to hepatitis B is very high, liver transplantation is the unique means to cure hepatic failure with poor prognosis. To assess the hepatic functional reserve, operative risk and prognosis of patients with cirrhosis, liver function can be analyzed by classification or quantization. Child-Turcotte-Pugh(CTP)classification has been traditionally utilized , however, when the CTP system used as a disease severity index to determine priority in organ allocation, it has a number of limitations. Thus, Malinchoc etc promoted the model for end-stage liver disease (MELD) as a disease severity index for patients with end-stage liver disease awaiting liver transplantation in 2000. The MELD score is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities. However, this model still has some disadvantages. Recent years, scoring system added by new parameters based on MELD score has been verified to have advantages on predicting mortality in certain patients. Some studies confirmed that MELD score accompanied by serum cholesterol level is an accurate measure of short-term mortality risk in patients with end-stage liver disease . To investigate the value of combination of MELD and serum cholesterol level in predicting short-term and mideian-term prognosis of patients with decompensated liver cirrhosis caused by hepatitis B virus.Objective: 1. To assess the prognosis of patients with hepatitis B-induced decompensated cirrhosis by means of model for end-stage liver disease (MELD) scoring, serum total cholesterol (TC) level, and Child-Pugh grading and to predict the short-term and mideian-term mortality .2. To investigate the relationship between mortality and complications related to portal hypertension of patients with hepatitis B-induced decompensated cirrhosis.Methods: A total of 77 patients with decompensated liver cirrhosis due to hepatitis B hospitalized in the first affiliated hospital of Anhui medical university from Dec.2007 to Sep. 2009 were enrolled into the study. The follow-up time was 3 or 6 months. The study was to compare death and survival groups which were divided according to MELD score (MELD≤9, 10≤MELD≤19, 20≤MELD≤29 or MELD≥30),CTP classification (A,B or C grade) and serum cholesterol level respectively, and to calculate mortality in 3 months. The survival rates were compared in different groups divided by the follow-up time. The accuracies of the three parameters in predetermining the prognosis were analyzed by using the receiver operating characteristic (ROC) curve. Kaplan-Meier survival curves were made using the cut-offs identified by means of receiver operating characteristic (ROC). Meanwhile to analyze the relation of TC and the prognosis within a single MELD.Results: 20 patients died within 3 months, the mortality in 3 months was 25.97%. There were significant differences in MELD score between 3-month death and survival groups (X2=29.09,P=0.000). The mortality in 3 months of those with MELD≤9, 10~19, 20~29 or≥30 was 0.00%,10.00%,47.37%,87.50% respectively. There were evident differences in CTP score between the two groups (x2=6.972,P=0.031). Mortality in 3 months of the groups which were divided by Child A,B or C were 0.00%、18.18%、38.89% respectively. The incidences of complications (severe ascites, hepatic encephalopathy, upper gastrointestinal bleeding) of death group were much higher than those of survival group. After following up for 3 or 6 months, the level of serum cholesterol of deaths was lower than that of survivals, while MELD and CTP score was higher (p<0.01). The correlation analysis revealed that a positive correlation between MELD and CTP score(r=0.702,p=0.000), while a negative correlation between MELD score and serum total cholesterol(r=-0.353,p=0.002). The areas under ROC curve (AUC) of CTP, MELD and serum total cholesterol were 0.725、0.898、0.768 for 3-month follow-up time respectively, while 0.753、0.898、0.769 for 6-month follow-up time respectively. Survival curves showed that the MELD、CTP and TC were all clearlydiscriminated the patients who survived or died in short-term as well as intermediate-term (P < 0.01).Conclusion: 1. Compared with prognosis of patients, that with lower MELD scores was superior to that with higher ones, Child A outstripped Child C, while patients with low serum cholesterol level had a worse prognosis.2.The results suggested that all of MELD score, CTP classification and serum cholesterol level could accurately predict the short-term prognosis of patients with hepatitis B-induced decompensated cirrhosis,but MELD score could not completely replace CTP classification. MELD and CTP score should be both considered in predicting prognosis of patients with decompensated cirrhosis. The involvement of serum sodium could improve the values of MELD model, but was still of limited value.3.The incidences of severe complications for deaths were higher than those for survivals, which had significance in predicting prognosis.