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Adding C‐reactive protein and procalcitonin to the model of end‐stage liver disease score improves mortality prediction in patients with complications of cirrhosis
Author(s) -
Chirapongsathorn Sakkarin,
Bunraksa Worawan,
Chaiprasert Amnart,
Punpanich Dollapas,
Supasyndh Ouppatham,
Kamath Patrick S
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13928
Subject(s) - medicine , procalcitonin , cirrhosis , model for end stage liver disease , gastroenterology , confidence interval , liver disease , cohort , odds ratio , c reactive protein , prospective cohort study , surgery , sepsis , liver transplantation , transplantation , inflammation
Background and Aim This study aims to determine the performance of models adding C‐reactive protein (CRP) and procalcitonin (PCT) to the model of end‐stage liver disease (MELD) score for mortality prediction in patients hospitalized with complications of cirrhosis. Methods A prospective cohort study was carried out in consecutive cirrhotic patients admitted with complications of cirrhosis between September 2012 and 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 1288 cirrhotic patients diagnosed between 2010 and 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 odds ratio (OR) 1.19 (95% confidence interval [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.