Comparison of Prognosis in Patients with Liver Cirrhosis and its Correlation with the Model for the End-Stage Liver Disease and Child-Pugh Scores in Patients with Esophageal or Gastric Variceal Bleeding

Seyedeh Masoumeh Pashai, Mohsen Ebrahimi, Mohammad Reza Sheikhian

Background

Variceal bleeding is one of the most serious complications of cirrhosis. Up to now different methods are created for predicting the complications and mortality of cirrhosis. Child- Pugh score and MELD score are two methods for this use. In this study we investigated and compared survival prognosis of cirrhotic patients by the Child-Pugh or MELD score in two groups of esophageal and gastric variceal bleeding.

Materials and Methods

In this cross-sectional trial, patients with upper GI bleeding were followed up for a 6 months period. The source of hemorrhage was determined by endoscopy, then patients distributed in two groups of esophageal and gastric variceal hemorrhage. Finally we investigated and compared the relationship between the variables and mortality rates in these two groups by means of the Child-Pugh and the MELD scores. The Student's t-test and Receiver Operating Characteristic were used for statistical analysis.

Results

34 patients (12 with gastric varices, 22 with esophageal varices) were investigated. No significant difference between these two groups was observed. In this study mean MELD score was 16.67±8.75 and mean Child-Pugh score was 9.37±2.54. Eight patients (5 with gastric varices and 3 with esophageal varices) expired before 6 weeks and 2 patients (one four each group) expired after 6 weeks. The best cut-off points are 15.5 and 10.5 for MELD and Child-Pugh scores respectively (sensitivity and specificity are 0.75 and 0.98, respectively for both scores).

Conclusion

Sensitivity and specificity of both scores were the same in prediction of mortality. However, the chance ratio defined that Child-Pugh score was a better predictor of mortality than MELD score, since the chance of death will increase 2.51 and 1.62 fold per each unit increase in the Child-Pugh and the MELD scores, respectively. However, no significant difference found between Child-Pugh and MELD score between two groups of patients.

Liver Diseases; Esophageal and Gastric Varices; Mortality

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