TY - JOUR
T1 - Child-Turcotte score versus MELD for prognosis in a randomized controlled trial of emergency treatment of bleeding esophageal varices in cirrhosis
AU - Orloff, Marshall J.
AU - Vaida, Florin
AU - Isenberg, Jon I.
AU - Wheeler, Henry O.
AU - Haynes, Kevin S.
AU - Jinich-Brook, Horacio
AU - Rapier, Roderick
AU - Hye, Robert J.
AU - Orloff, Susan L.
N1 - Funding Information:
The authors thank the many residents at the Department of Medicine and the Department of Surgery at UCSD Medical Center who had a major role in the care of patients in this study. They thank the many physicians practicing in the counties of San Diego, Imperial, Orange, and Riverside, who helped with patient recruitment, referral, and long-term follow-up. They thank Professors Harold O. Conn, Haile T. Debas, and Peter Gregory, who served voluntarily as an External Advisory, Data Safety, and Monitoring Committee. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. It was also supported by grant 1 R01 DK41920 from the National Institutes of Health and a grant from the Surgical Education and Research Foundation [501(c)(3)] ( clinicaltrials.gov NCT00690027 ).
PY - 2012/11
Y1 - 2012/11
N2 - Background and Aims: Bleeding esophageal varices is responsible for much of the high mortality rate in cirrhosis. An important objective of management of bleeding varices is to develop reliable tools for predicting survival, controlling bleeding and encephalopathy, and improve quality of life. This study compared two widely used prognostic tools, the model for end-stage liver disease (MELD) and the Child-Turcotte (C-T) score, in a randomized controlled trial of emergency treatment of bleeding varices. Methods: We randomized 211 unselected consecutive patients with cirrhosis and bleeding varices to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnosis and treatment were accomplished within 20 hours. Follow-up was 100% for 10 y. We compared the prognostic powers of MELD and C-T upon entry, and then monthly for the first year and every 3 months thereafter. Statistical analysis included computation of receiver operating curves, the area under the curve, and the proportion of variability. Results: In baseline determinations of MELD versus C-T, there were no significant differences in predicting survival, recurrent encephalopathy, and rebleeding. The Child-Turcotte score was a stronger predictor than MELD of hospital readmissions and readmission days. In serial determinations over years, the prognostic power of both MELD and C-T was substantial, but C-T was significantly more effective in predicting survival and time to recurrent encephalopathy. Conclusions: In this first long-term comparison of MELD versus C-T in cirrhosis with bleeding varices, C-T was consistently as effective as MELD in predicting survival, encephalopathy, rebleeding, hospital readmissions, and readmission days. In some measures, C-T was a more effective prognostic tool than MELD.
AB - Background and Aims: Bleeding esophageal varices is responsible for much of the high mortality rate in cirrhosis. An important objective of management of bleeding varices is to develop reliable tools for predicting survival, controlling bleeding and encephalopathy, and improve quality of life. This study compared two widely used prognostic tools, the model for end-stage liver disease (MELD) and the Child-Turcotte (C-T) score, in a randomized controlled trial of emergency treatment of bleeding varices. Methods: We randomized 211 unselected consecutive patients with cirrhosis and bleeding varices to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnosis and treatment were accomplished within 20 hours. Follow-up was 100% for 10 y. We compared the prognostic powers of MELD and C-T upon entry, and then monthly for the first year and every 3 months thereafter. Statistical analysis included computation of receiver operating curves, the area under the curve, and the proportion of variability. Results: In baseline determinations of MELD versus C-T, there were no significant differences in predicting survival, recurrent encephalopathy, and rebleeding. The Child-Turcotte score was a stronger predictor than MELD of hospital readmissions and readmission days. In serial determinations over years, the prognostic power of both MELD and C-T was substantial, but C-T was significantly more effective in predicting survival and time to recurrent encephalopathy. Conclusions: In this first long-term comparison of MELD versus C-T in cirrhosis with bleeding varices, C-T was consistently as effective as MELD in predicting survival, encephalopathy, rebleeding, hospital readmissions, and readmission days. In some measures, C-T was a more effective prognostic tool than MELD.
KW - Bleeding varices
KW - Child-Turcotte
KW - MELD
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U2 - 10.1016/j.jss.2012.01.004
DO - 10.1016/j.jss.2012.01.004
M3 - Article
C2 - 22480831
AN - SCOPUS:84868211772
SN - 0022-4804
VL - 178
SP - 139
EP - 146
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -