Child-Pugh Versus MELD Score For The Assessment Of Prognosis In Liver Cirrhosis:Meta-analysis And Retrospective Observational Studies

Background and Aims:Child-Pugh and Model for End-Stage Liver Disease(MELD)scores have been widely used for the assessment of prognosis in liver cirrhosis.It remains controversial about whether Child-Pugh or MELD score is better for predicting the prognosis in cirrhotic patients.A systematic review and meta-analysis aimed to compare the discriminative ability of Child-Pugh versus MELD score to assess the prognosis of cirrhotic patients.We also conducted two retrospective observational studies to explore this issue.The first was to compare the discriminative ability of Child-Pugh and MELD scores in predicting the in-hospital mortality in cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB)in our hospital,and the second was to compare the discriminative ability of Child-Pugh and MELD scores in predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure(ACLF).Methods:1.Pub Med and EMBASE databases were searched.The statistical results were summarized from every individual study.The summary areas under receiver operating characteristic curves(AUSROCs),sensitivities,specificities,positive likelihood ratios(PLRs),negative likelihood ratios(NLRs),and diagnostic odds ratios(DORs)were also calculated.2.A retrospective study was conducted to compare the performance of Child-Pugh and MELD scores for predicting the in-hospital mortality of AUGIB in cirrhotic patients who admitted to our hospital between July 2013 and June 2014.We calculated the AUROC(areas under receiver operating characteristic curve)with 95%CI(confidence interval),sensitivity,specificity and cutoff value of Child-Pugh and MELD scores in predicting the risk of in hospital death.3.A retrospective study was conducted to compare the performance of Child-Pugh and MELD scores for predicting the in-hospital mortality of ACLF in cirrhotic patients who admitted to our hospital between January 2010 and June 2014.ACLF patients were divided into two groups according to APASL(the Asia-Pacific Association for the Study of the Liver)criteria and EASL/AASAL(the American Association for the Study of Liver Diseases)criteria,respectively.We calculated the AUROC with 95%CI,sensitivity,specificity,cutoff value,PLR,and NLR of Child-Pugh and MELD scores in predicting the in hospital mortality in these two groups,respectively.Results:1.Of the 1095 papers initially identified,119 were eligible for the systematic review.Study population was heterogeneous among studies.They included 269 comparisons,of which 44 favored MELD score,15 favored Child-Pugh score,100 didn't find any significant difference between them,and 110 didn't report the statistical significance.Forty-two papers were further included in the meta-analysis.In patients with ACLF,Child-Pugh score had a higher sensitivity and a lower specificity than MELD score.In patients admitted to ICU(intensive care unit),MELD score had a smaller NLR and a higher sensitivity than Child-Pugh score.In patients undergoing surgery,Child-Pugh score had a higher specificity than MELD score.Child-Pugh and MELD scores had statistically similar discriminative abilities in some subgroups(i.e.,patients with alcohol alone related liver cirrhosis,liver transplantation candidates,patients undergoing TIPS(transjugular intrahepatic portosystemic shunts),and 12-month mortality as the endpoint).Child-Pugh and MELD scores could not be compared due to the presence of significant diagnostic threshold effects in other groups(i.e.,AUGIB,patients with HBV(hepatitis B virus)alone related liver cirrhosis,in-hospital mortality,3-month mortality and 6-month mortality as the endpoint).2.A total of 145 patients with a diagnosis of liver cirrhosis and AUGIB were retrospectively analyzed.The in-hospital mortality was 8%(11/145).AUROCs for predicting the in-hospital mortality for Child-Pugh and MELD scores were 0.796(95%CI: 0.721-0.858)and 0.807(95% CI: 0.733-0.868),respectively.The discriminative ability was not significant different between the two scoring systems(P = 0.7796).3.One hundred patients were eligible for APASL criteria.The in-hospital mortality was 23.0%(23/100).AUROCs of Child-Pugh and MELD scores in predicting the in-hospital mortality were 0.63(95%CI: 0.523-0.720,P=0.05)and 0.75(95%CI:0.65-0.83,P<0.0001),respectively.The discriminative ability was not significant different between the two scoring systems(P=0.09).Eighty-eight patients were eligible for EASL/AASLD criteria.The in-hospital mortality was 35.2%(31/88).AUROCs of Child-Pugh and MELD scores in predicting the in-hospital mortality were 0.59(95%CI: 0.48-0.69,P=0.14)and 0.57(95%CI:0.46-0.68,P=0.26),respectively.There was no significant difference between the two scores(P=0.86).Conclusion:1.Although Child-Pugh and MELD scores had similar prognostic values in most of cases,their benefits might be heterogeneous in some specific conditions.The indications for Child-Pugh and MELD scores should be further identified.2.Child-Pugh and MELD scores were similar for predicting the in-hospital mortality of AUGIB in cirrhotic patients.3.Child-Pugh and MELD scores might not be effective in predicting the in-hospital mortality of cirrhotic patients with ACLF.