Evaluation of the increase in model for end-stage liver disease (ΔMELD) score over time as a prognostic predictor in patients with advanced cirrhosis:: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score

Background/Aims: The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. The change in MELD score over time (Delta MELD) may have additional prognostic value. We investigated the ability of Delta MELD to predict the outcome of advanced cirrhosis and prospectively assessed the factors associated with increasing Delta MELD. Methods: Risk factors were determined in 58 prospectively followed-up patients. The predictive power of Delta MELD, initial MELD and Child-Turcotte-Pugh (CTP) score was compared by using c-statistic in 351 patients. Results: Ascites (P=0.020) and hepatic encephalopathy (P=0.023) were significantly associated with increasing MELD score at 3 months. The area under receiver operating characteristic (ROC) curve for Delta MELD/month was 0.779 compared with 0.718 for MELD (P = 0.130) and 0.528 for CTP score (P < 0.001) at 6 months; the area was 0.822, 0.744 and 0.528, respectively (P=0.018 and <0.001, respectively) at 12 months. Delta MELD/month >2.5 was the only significant prognostic predictor at 6 (odds ratio: 9.8, P<0.001) and 12 months (odds ratio: 16.3, P<0.001) in multivariate logistic analysis. Conclusions: Increasing MELD score is associated with the onset of ascites and encephalopathy. Delta MELD is superior to initial MELD and CTP scores to predict intermediate term outcome in patients with advanced cirrhosis. (C) 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.