1. Recalibrating the Child–Turcotte–Pugh Score to Improve Prediction of Transplant-Free Survival in Patients with Cirrhosis
- Author
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Kaplan, David E, Dai, Feng, Skanderson, Melissa, Aytaman, Ayse, Baytarian, Michelle, D’Addeo, Kathryn, Fox, Rena, Hunt, Kristel, Knott, Astrid, Mehta, Rajni, Pedrosa, Marcos, Pocha, Christine, Valderrama, Adriana, Taddei, Tamar, and for the VOCAL Study Group
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Transplantation ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Adult ,Aged ,Bilirubin ,Creatinine ,Disease Progression ,End Stage Liver Disease ,Evidence-Based Medicine ,Female ,Humans ,International Normalized Ratio ,Liver Cirrhosis ,Liver Transplantation ,Male ,Middle Aged ,Odds Ratio ,Prognosis ,Proportional Hazards Models ,Retrospective Studies ,Serum Albumin ,Severity of Illness Index ,United States ,Veterans ,VOCAL Study Group ,Cirrhosis ,Human ,MELD ,Natural history ,Predictive models ,Survival ,Gastroenterology & Hepatology ,Clinical sciences - Abstract
BackgroundThe Child-Turcotte-Pugh (CTP) score is a widely used and validated predictor of long-term survival in cirrhosis. However, the cutpoints for stratifying laboratory variables in CTP have never been validated.ObjectiveThe objective of this study was to identify evidence-based cutpoints for the CTP laboratory subscores to improve its predictive capacity for transplant-free survival.DesignRetrospective observational study.Data sourceUsing a cohort of 30,897 cirrhotic US Veteran patients with at least 5 years of follow-up, we performed Cox proportional hazard survival model iterations varying the upper and lower cutpoints for INR, total bilirubin and albumin CTP subscores. Cutpoints yielding the highest Harrell's C-statistics for concordance with transplant-free survival were incorporated into a modified CTP (mCTP) score. Validation of the mCTP was performed at multiple time frames within the follow-up period of the cohort and within subsets defined by disease etiology.ResultsModification of CTP cutpoints increased the Harrell's C-statistic for age- and gender-adjusted Cox proportional hazard models from 0.701 ± 0.002 to 0.709 ± 0.002 and the risk ratio per unit change from 1.49 (1.48-1.50) to 1.53 (1.52-1.54). The modified cutpoints showed superiority in predicting 5-year transplant-free survival in various disease etiology subgroups. A mCTP substituting serum creatinine for INR performed superiorly for predicting 5-year transplant-free survival.ConclusionWe propose an evidence-based recalibration of CTP score cutpoints that optimizes this model's capacity to predict transplant-free survival in patients with cirrhosis. The CTP score remains the best predictor of 5-year overall and transplant-free survival in patients with cirrhosis.
- Published
- 2016