Prognostic Models for Survival in Patients with Stable Cirrhosis: A Multicenter Cohort Study

Two models are mostly used to predict survival in cirrhosis: the Child–Pugh score (CP score) and the model for end-stage liver disease score (MELD score). The aim of this study is to evaluate the CP score and the MELD score for short- and long-term prognosis in cirrhosis, as well as CP-creatinine score, MELD-Na score, and UKELD score. One thousand and forty-seven patients from five referral centers were included: men/women: 620/427, median age: 58 years (IQR 48–66), median follow-up: 33 months (IQR 12–74), CP (A/B/C): 493/357/147, CP score: 7 (IQR 5–9), MELD score: 12 (IQR 9–16). The performance of each score was evaluated by the Cox hazard model in terms of their: discrimination ability (C-index and Somer’s D) and calibration (3, 12 months). Internal validation was done with bootstrapping (100 samples). Three hundred and fifty-two patients (33.6%) died. All scores were significantly associated with overall mortality, when assessed by univariate Cox analysis. CP-creatinine score performed significantly better than all other scores [bootstrap C-index 0.672, 95% CI 0.642–0.703, bootstrap Somer’s D 0.344 (0.285–0.401)], apart from CP score, which showed similar performance. Inclusion in the multivariable Cox model of age together with CP-creatinine score improved the discriminative ability of the model [bootstrap C-index (95% CI) 0.700 (0.661–0.740)]. In terms of calibration, CP-creatinine score was the best for both 3- and 12-month survival in the total population. CP score and CP-creatinine score have better prognostic value compared to MELD score, MELD-Na score, and UKELD score for predicting short- and long-term mortality in patients with stable cirrhosis.