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A New Recalibrated Four-Category Child–Pugh Score Performs Better than the Original Child–Pugh and MELD Scores in Predicting In-Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real-World Cohort Analysis

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Abstract

Background

There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child–Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child–Pugh (rCP).

Methods

This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves.

Results

During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50–0.670) and MELD (AUROC 0.62, 95% CI 0.51–0.73) to predict rebleeding (p = 0.72), or between the Child–Pugh (AUROC 0.75, 95% CI 0.71–0.81) and MELD (AUROC 0.71, 95% CI 0.62–0.80) to predict death (p = 0.35). The rCP classification (A–D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77–0.89) compared to the CP score (A–C) and MELD to predict death (p = 0.004).

Conclusion

A recalibrated Child–Pugh score outperforms the original Child–Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.

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Authors and Affiliations

  1. Department of Surgery, J45 OMB, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa

    Jake Krige, Richard T. Spence & Eduard Jonas

  2. Surgical Gastroenterology and HPB Unit, Groote Schuur Hospital, Cape Town, South Africa

    Jake Krige & Eduard Jonas

  3. Department of Surgery, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Richard T. Spence, Marius Hoogerboord & James Ellsmere

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  1. Jake Krige
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  2. Richard T. Spence
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  4. Marius Hoogerboord
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Correspondence to Jake Krige.

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Krige, J., Spence, R.T., Jonas, E. et al. A New Recalibrated Four-Category Child–Pugh Score Performs Better than the Original Child–Pugh and MELD Scores in Predicting In-Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real-World Cohort Analysis. World J Surg 44, 241–246 (2020). https://doi.org/10.1007/s00268-019-05211-8

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  • DOI: https://doi.org/10.1007/s00268-019-05211-8

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