Adding C-reactive protein and procalcitonin to the MELD score improves mortality prediction in patients with complications of cirrhosis.
J Gastroenterol Hepatol. 2017 Aug 25;:
Authors: Chirapongsathorn S, Bunraksa W, Chaiprasert A, Punpanich D, Supasyndh O, Kamath PS
Abstract
OBJECTIVE: To determine the performance of models adding C-reactive protein (CRP) and procalcitonin (PCT) to the MELD score for mortality prediction in patients hospitalized with complications of cirrhosis.
PATIENTS AND METHODS: A prospective cohort study was carried out in consecutive cirrhotic patients admitted with complications of cirrhosis between September 2012 to December 2013 at Phramongkutklao Hospital, Bangkok, Thailand. All patients had venous CRP, PCT and laboratory values for MELD score calculation measured at emergency room or admission. Cox regression analysis and the c-statistic were used to predict mortality. The MELD-CRP score was externally validated in 818 eligible patients from Mayo Clinic, Rochester using data from 1,288 cirrhotic patients diagnosed between 2010-2014.
RESULTS: A cohort of 177 patients with cirrhosis was admitted during the study period. Seventy-one patients were eligible for analysis. The MELD score was predictive of 90-day mortality OR 1.19 (95%CI; 1.09-1.32). Adding CRP and/or PCT to the MELD score improved the predictive of 90-day mortality: MELD-CRP OR 2.71 (95% CI; 1.66-4.99); MELD-PCT OR 2.72 (95% CI; 1.66-4.99); MELD-CRP-PCT OR 2.71 (95% CI; 1.67-4.92). The c-statistics for MELD, MELD-CRP, MELD-PCT, and MELD-CRP-PCT were 0.81, 0.83, 0.84, and 0.85 respectively. Adding CRP and/or PCT to the MELD score also improved 30-day mortality prediction. Similar results for the MELD-CRP score were obtained from the Mayo Clinic external validation cohort.
CONCLUSION: The MELD-CRP, MELD-PCT and MELD-CRP-PCT scores may be superior to the MELD score alone in predicting mortality in patients hospitalized with complications of cirrhosis.
PMID: 28840619 [PubMed - as supplied by publisher]