Archives of Public Health

Vol. 13 No. 2 (2021): Archives of Public Health
Clinical Science

Predictive potential of the MELD and Child-Turcotte-Pugh II scores for SBP in patients with cirrhosis and ascites

OnlineFirst PDF
  • Fana Lichoska-Josifovikj,
  • Kalina Grivcheva-Stardelova,
  • Beti Todorovska,
  • Magdalena Genadieva Dimitrovа,
  • Lidija Petkovska,
  • Meri Trajkovska
Fana Lichoska-Josifovikj
University Clinic of Gasteroenterohepatology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Kalina Grivcheva-Stardelova
University Clinic of Gasteroenterohepatology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Beti Todorovska
University Clinic of Gasteroenterohepatology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Magdalena Genadieva Dimitrovа
University Clinic of Gasteroenterohepatology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Lidija Petkovska
University Clinic of Toxycology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Meri Trajkovska
University Clinic of Gasteroenterohepatology; Ss Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
DOI: https://doi.org/10.3889/aph.2021.6022

Published 2021-11-20

Keywords

  • spontaneous bacterial peritonitis,
  • Child-Turcotte-PughII score,
  • MELD score

How to Cite

1.
Lichoska-Josifovikj F, Grivcheva-Stardelova K, Todorovska B, Genadieva Dimitrovа M, Petkovska L, Trajkovska M. Predictive potential of the MELD and Child-Turcotte-Pugh II scores for SBP in patients with cirrhosis and ascites. Arch Pub Health [Internet]. 2021 Nov. 20 [cited 2024 Apr. 18];13(2):101-9. Available from: https://id-press.eu/aph/article/view/6022

Copyright (c) 2021 Fana Lichoska-Josifovikj, Kalina Grivcheva-Stardelova, Beti Todorovska, Magdalena Genadieva Dimitrovа, Lidija Petkovska, Meri Trajkovska

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

It is very important for patients with spontaneous bacterial peritonitis (SBP) to assess the length of survival and the risk of death, primarily because of the wide range of potential complications that can lead to multisystem organ failure and fatal outcome. The aim of this study was to determine the predictive potential of MELD and Child-Turcotte-Pugh II score for SBP in patients with cirrhosis and ascites. Material and methods: The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included 70 hospitalized patients with established liver cirrhosis, regardless of etiology, divided into two groups, 35 patients with SBP and 35 non-SBP. Prognostic scores in patients with liver cirrhosis and ascites: MELD score, according to the formula: MELD = [(0.957 x Ln Creatinin) + (0.378 x Ln Bilirubin) + (1.12 x Ln INR) + (0.643) x 10]. The Child-Turcotte-Pugh II score includes 6 parameters: serum albumin and bilirubin, amount of ascites, degree of encephalopathy ( HE), prothrombin time (PT) and serum creatinine, and assessment of the degree of hepatic encephalopathy according to the West Haven criteria. Results: The average value of the MELD score in patients with SBP was 22.6 ± 8.27 and in non-SBP the average value was lower - 17.83±5.87. According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = 2.41; p = 0.015). A score of 30 to 39 was registered in 25.7% of patients with SBP, and only in 2.9% in non-SBP; the percentage difference was statistically significant for p <0.05 (Difference test, p = 0.0064 ). Patients with SBP had an average Child-Pugh score of 13.09 ± 2.48 or 100.0% C-class points. In patients with non-SBP, an average child-Pugh score of 9.63 ± 1.62 was recorded, or class B in 65.7% and class C in 34.3%. The percentage difference was statistically significant for p <0.05 (Difference test, p = 0.000000). According to the Mann-Whitney U test, the difference between the mean values ​​was statistically significant for p <0.05 (z = -5.44; p = 0.00001). ROC analysis indicated that the Child-Turcotte-Pugh II score contributed to the diagnosis of SBP - 90.7% (p = 0.000) (excellent predictor), closer to the ideal value of 1.0 and above the worst value of 0.5. ROC analysis indicated that the MELD score did not contribute to the diagnosis of SBP - 66.7% (p = 0.017) (weak predictor), closer to the worst value of 0.5. Conclusion:Our research confirmed that SBP occurs in patients with severe hepatic dysfunction calculated according to the CTP II score and MELD score. Mean value of the MELD score in patients with SBP was higher then in patients with non-SBP. On the other hand all patients with SBP had an average CTP II score, C-class points,  while the largest percentage of patients with non-SBP were class B-class points. MELD score is a weak predictor of SBP.  The best predictor for predicting SBP is the CTP II score (rank C).

OnlineFirst PDF

Downloads

Download data is not yet available.

References

  1. Child C, Turcotte J. The liver and portal hypertension. In:Child CI, ed. Surgery and Portal Hypertension. Philadelphia,USA: W. B. Saunders, 1964: 50–8.
  2. Pugh R, Murray-lyon I, Dawson J. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg1973; 60: 646–9. DOI: https://doi.org/10.1002/bjs.1800600817
  3. Vorobioff J, Groszmann RJ, Picabea E, et al. Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: A 10-year prospective study. Gastroenterology 1996;111(3):701-9. DOI: https://doi.org/10.1053/gast.1996.v111.pm8780575
  4. Shah DN, Ventura-Cots M, Abraldes JG, et al. Alcohol-related liver disease is rarely detected at early stages compared with liver diseases of other etiologies worldwide. Clin Gastroenterol Hepatol 2019;17(11):2320-2329. DOI: https://doi.org/10.1016/j.cgh.2019.01.026
  5. Planas R, Balleste B, Alvarez MA, Rivera M, Montoliu S, Galeras JA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol 2004;40:823-30. DOI: https://doi.org/10.1016/j.jhep.2004.01.005
  6. Shetty K, Rybicki L, Carey WD. The Child-Pugh classification as a prognostic indicator for survival in primary sclerosing cholangitis. Hepatology 1997;25:1049-53. DOI: https://doi.org/10.1002/hep.510250501
  7. Zeitoun G, Escolano S, Hadengue A, et al. Outcome of Budd-Chiari syndrome: a multivariate analysis of factors related to survival including surgical portosystemic shunting. Hepatology 1999;30:84-9. DOI: https://doi.org/10.1002/hep.510300125
  8. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application on survival models to liver allocation. Liver Transpl 2001;7:567-80.
  9. Dharel N, Bajaj JS. Definition and nomenclature of hepatic encephalopathy. J Clin Exp Hepatol 2015 Mar;5(Suppl 1):S37-41 DOI: https://doi.org/10.1016/j.jceh.2014.10.001
  10. Angermayr B, Cejna M, Karnel F,et al. Child-Pugh versus MELD score in predicting survival in patients undergoingtransjugular intrahepatic portosystemic shunt. Gut 2003; 52:879–85. DOI: https://doi.org/10.1136/gut.52.6.879
  11. Samiullah S, Qasim R, Khalid S, Hussain BG, Mukhtair J, Akbar Y. Evaluation of creatininemodified Chid-Pugh skore for predicting short-term prognosis of patients with decompensated cirrhosis of liver as compare to original Child-Pugh score. J Ayub Med Coll Abbottabad 2009;21(2):64-7.
  12. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular portosystemic intrahepatic portosystemic shunts. Hepatology 2000;31:864-71. DOI: https://doi.org/10.1053/he.2000.5852
  13. Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, Lucey MR. Model of endstage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004;40:897-903. DOI: https://doi.org/10.1016/j.jhep.2004.02.010
  14. Martin AP, Bartels M, Hauss J, Fangmann J. Overview of the MELD score and the UNOS adult liver allocation system. Transplant Proc 2007;39:3169-74. DOI: https://doi.org/10.1016/j.transproceed.2007.04.025
  15. Ravaioli M, Grazi GL, Ballardini G, et al. Liver transplantation with the Meld system: a prospective study from a single European center. Am J Transplant 2006;6:1572-7. DOI: https://doi.org/10.1111/j.1600-6143.2006.01354.x
  16. Schepke M, Roth F, Fimmers R, Brensing KA, Sudhop T, Schild HH, Sauerbruch T. Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting. Am J Gastroenterol 2003;98: 1167-74. DOI: https://doi.org/10.1111/j.1572-0241.2003.07515.x
  17. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application on survival models to liver allocation. Liver Transpl 2001;7:567-80. DOI: https://doi.org/10.1053/jlts.2001.25879
  18. Thanopoulou AC, Koskinas JS, Hadziyannis SJ. Spontaneous bacterial peritonitis (SBP): clinical, laboratory, and prognostic features. A single-center experience. Eur J Intern Med 2002;13(3):194-8. DOI: https://doi.org/10.1016/S0953-6205(02)00027-4
  19. Oladimeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunle DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites. Pan Afr Med J 2013;15:128. DOI: https://doi.org/10.11604/pamj.2013.15.128.2702
  20. Coral G, Mattos AA, Damo DF, Viégas AC. Prevalence and prognosis of spontaneous bacterial peritonitis. Experience in patients from a general hospital in Porto Alegre, RS, Brazil (1991-2000). Arq Gastroenterol 2002; 39(3):158-62. 1. DOI: https://doi.org/10.1590/S0004-28032002000300005
  21. Such J, Runyon BA. Spontaneous bacterial peritonitis. Clin Infect Dis 1998;27:669–74. DOI: https://doi.org/10.1086/514940
  22. Heo J, Seo YS, Yim HJ, et al. Clinical features and prognosis of spontaneous bacterial peritonitis in korean patients with liver cirrhosis: a multicenter retrospective study. Gut Liver 2009;3(3): 197-204. DOI: https://doi.org/10.5009/gnl.2009.3.3.197
  23. Kasztelan-Szczerbinska B, Slomka M, Celinski K, et al. Prevalence of spontaneous bacterial peritonitis in asymptomatic inpatients with decompensated liver cirrhosis – a pilot study. Adv Med Sci 2011;56(1):13-7. DOI: https://doi.org/10.2478/v10039-011-0010-6
  24. Haddad L, Conte TM, Ducatti L, et al. MELD Score is not related to spontaneous bacterial peritonitis. Gastroenterol Res Pract 2015;2015:270456. DOI: https://doi.org/10.1155/2015/270456
  25. Zhang QB, Chen YT, Lion GD, Qian CC, Chen SJ, Huang KH. A combination of models for end-stage liver disease and cirrhosis-related complications to predict the prognosis of liver cirrhosis. Clin Res Hepatol Gastroenterol 2012;36:583-9. DOI: https://doi.org/10.1016/j.clinre.2012.04.014
  26. Obstein KL, Campbell MS, Reddy RK, et al. Association between model for end-stage liver disease and spontaneous bacterial peritonitis. Am J Gastroenterol 2007;102(12):2732-6. DOI: https://doi.org/10.1111/j.1572-0241.2007.01485.x
  27. Gayatri AA, Suryadharma IG, Purwadi N, Wibawa D. The relationship between a model of end stage liver disease score (MELD score) and the occurrence of spontaneous bacterial peritonitis in liver cirrhotic patients. Acta Medica Indonesiana 2007; 39(2): 75-78.
  28. Oey RC, van Buuren HR, de Jong DM, et al. Bacterascites: A study of clinical features, microbiological findings, and clinical significance. Liver Int 2018;38(12):2199-2209. DOI: https://doi.org/10.1111/liv.13929
  29. Desai AP, Reau N, Reddy G, et al. Persistant spontaneous bacterial peritonitis: a common complications in patients with spontaneous bacterial peritonitis and a high score in the model for end-stage liver disease. Ther Adv Gastroenterol 2010;5(5):275-83. DOI: https://doi.org/10.1177/1756283X11417037

Most read articles by the same author(s)