Diabetes Y Cirrosis Hepatica

230

A Hepatology 2008; 7(3): 2008: 230-234
Annals of nnals of Hepatology 7(3)July-September: 230-234

Original Article
Annals
of
Hepatology

Model for end stage of liver disease (MELD)
is better than the Child-Pugh score for
predicting in-hospital mortality related to
esophageal variceal bleeding
Ángel Ricardo Flores-Rendón;1 José Alberto González-González;1 DiegoGarcía-Compean;1
Héctor Jesús Maldonado-Garza;1 Aldo Azael Garza-Galindo1

Abstract
Aim: The Child Pugh and MELD are good methods for
predicting mortality in patients with chronic liver disease. We investigated their performance as risk factors
for failure to control bleeding, in-hospital overall mortality and death related to esophageal variceal bleeding episodes. Methods: From a previous collecteddatabase, 212 cirrhotic patients with variceal bleeding admitted to our hospital were studied. The predictive
capability of Child Pugh and MELD scores were compared using c statistics. Results: The Child-Pugh and
MELD scores showed marginal capability for predicting failure to control bleeding (the area under receiver
operating characteristics curve (AUROC) values were
< 0.70 for both). The AUROCvalues for predicting inhospital overall mortality of Child-Pugh and MELD
score were similar: 0.809 (CI 95%, 0.710 - 0.907) and
0.88 (CI 95% 0.77- 0.99,) respectively. There was no
significant difference between them (p > 0.05). The AUROC value of MELD for predicting mortality related
to variceal bleeding was higher than the Child-Pugh

1

Facultad de Medicina y Centro Regional para elEstudio de
Enfermedades Digestivas. (CREED) Hospital Universitario «Dr.
José Eleuterio González» UANL. Monterrey, N.L. México.

Address for correspondence:
José Alberto González-González
Facultad de Medicina y Centro Regional para el Estudio de
Enfermedades Digestivas. (CREED) Hospital Universitario «Dr.
José Eleuterio González» UANL. Monterrey, N.L. México.
Madero y Gonzalitos S/N Col.Mitras Centro, Monterrey, N.L.
México.
Phone: (52)(81)83333664.
Fax: (52)(81)83486068.
E-mail:joseagonz@yahoo.com

score: 0.905 (CI 95% 0.801-1.00) vs 0.794 (CI 95%
0.676 – 0.913) respectively (p < 0.05). Conclusions:
MELD and Child-Pugh were not efficacious scores for
predicting failure to control bleeding. The Child-Pugh
and MELD scores had similar capability for predictingin-hospital overall mortality. Nevertheless,
MELD was significantly better than Child-Pugh score
for predicting in-hospital mortality related to variceal bleeding.
Key words: Variceal bleeding, MELD, Child-Pugh, failure to control bleeding, esophageal varices.

Introduction
Esophageal variceal bleeding (EVB) in cirrhotic patients is one of the most severe complications and has a
mortality rate of13% to 30 %.1-3 Patients with advanced
liver disease are at higher risk to develop complications
or to die because of hypovolemic shock, infections and
liver failure.4,5
Diverse methods have been used for predicting complications and mortality rates in cirrhotic patients over
the last decades. One of the most used is the Child-Pugh
(CP) score. It was developed in 1973 as a modification ofthe Child-Turcotte´s score, by substituting the nutrition
status variable for prothrombin time.6
One limitation of the CP score is the use of two clinical parameters such as ascites and hepatic encephalopathy. The subjective assessment for grading these parameters can affect the reliability of the score.
Recently, a Model for End Stage of Liver Disease
(MELD) was designed in order todetermine the complication risks in patients with transjugular intrahepatic portosystemic shunts. 7 T his method comprises three
biochemical parameters: serum bilirrubin, prothrombin time and serum creatinine. MELD was also used in
cirrhotic patients with various clinical conditions, including renal failure, gallbladder surgery, liver transplant and acute alcoholic hepatitis. It has proved its...