Comparison Of Predictive Value Of CTP,MELD,MELD-Na,iMELD ABIC Scoring Models For Evaluating The Prognosis Of Patients With Alcoholic Liver Cirrhosis

Objectives:A variety of scoring models have been used to evaluate the prognosis of patients with liver disease,but each has strengths and weaknesses.In this study,we investigated the predictive value of six scoring systems:CTP(Child-Turcotte-Pugh)classification,model for end-stage liver disease(MELD),model for end-stage liver disease-sodium(MELD-Na),integrated model for end-stage of liver disease(iMELD),and age-bilirubin-INR-creatinie(ABIC)for death in patients with alcoholic liver cirrhosis(ALC),and analyzed the risk factors for death in patients with ALC.Methods:From January 2015 to December 2019,the clinical data of 91 patients with ALC diagnosed in Xiangxi Autonomous Prefecture People’s Hospital were analyzed retrospectively,and the scores of the six scoring systems were calculated with follow up.The area under the receiver operating characteristic curves(AUC)was used to compare the predictive value of the six scoring models for predicting the death of patients with ALC.The optimal cut-off value was determined according to the Youden index,and the Kaplan Meier survival curve was plotted using the cut-off value.The patients were divided into survival group and death group according to whether they survived at 12 and 24 months after admission.Two independent samples t-test or Mann-Whitney U test was used to compare the indicators between the two groups.Risk factors for death in patients with ALC were derived by Cox regression analysis.Results:1.MELD,MELD-Na,iMELD,CTP score and CTP grade had good predictive value for the death in ALC patients at 3 months,6 months,12 months,18months and 24 months,and there was no significant difference between every two groups(P>0.05);ABIC score had good predictive value for the death in ALC patients at 3 months,6 months and 12 months,but its AUC for predicting the death at 6 months and 12 months was lower than iMELD score(the difference was statistically significant(P<0.05)),whose predictive value for the death in ALC patients at 18 months and 24months was also poor.2.The sensitivity of MELD-Na score was the highest in predicting the death at 3months,6 months,12 months,and 24 months in ALC patients,and the scores are85.71%,90.91%,93.75%,and 85.19%,respectively,while the sensitivity of CTP score was the highest(79.17%)in predicting death at 18 months.And the specificity of iMELD score was the highest in predicting death at 3 months,6 months,12 months,18months,and 24 months in ALC patients,and the scores are 98.81%,95%,94.59%,97.01%,and 98.44%,respectively.3.Kaplan Meier survival curves were plotted using cut-off values,and the results showed that the 24-month survival rate of patients(MELD>7.92,MELD-Na>3.38,iMELD>31.67,ABIC>8.7,CTP score>8,and the CTP grade was C)was significantly lower,and the differences were statistically significant(P<0.05).4.The MON,TBil,DBil,Cr,PT,INR,APTT and CTP,ABIC,MELD-Na,iMELD,MELD scores of death group at 12 months were higher than those of survival group,and the LMR,Na~+,and Cl-were lower than those of survival group,and the differences were statistically significant(P<0.05).The MON%,MON,TBil,DBil,PT,INR,APTT and CTP,MELD-Na,iMELD,and MELD scores of death group at 24 months were higher than those of survival group,and the LMR,HCT,RBC,and ALB were lower than those of the survival group,and the differences were statistically significant(P<0.05).5.According to univariate Cox regression analysis,the increase of NEU,MON,TBil,DBil,AST,ALT,Cr,UA,PT,INR,APTT,CTP score,CTP grade,ABIC score,MELD score,MELD-Na score,iMELD score and the decrease of LMR,Na~+,and Cl~-were risk factors for the death in ALC patients at 12 months;the increase of MON,MON%,TBil,DBil,AST,ALT,Cr,PT,INR,APTT,CTP score,CTP grade,ABIC score,MELD score,MELD-Na score,iMELD score and the decrease of Na~+,RBC,and HCT level were risk factors for the death in ALC patients at 24 months.6.Multivariate Cox regression analysis showed that the decrease of Cl~-level was an independent risk factor for the death in ALC patients at 12 months,and the increase of MON and prolonged APTT were independent risk factors for the death in ALC patients at 24 months(P<0.05).Conclusions:1.MELD,MELD-Na,iMELD,CTP score and CTP grade have good predictive value for the prognosis of ALC patients at 3-24 months;ABIC score has a good predictive value for the short-term(3-12 months)prognosis of ALC patients,which performs poorly if it exceeds 12 months.2.The predictive value of MELD,MELD-Na and iMELD scores was the best for the short-term(3-12 months)prognosis of ALC patients,and MELD-Na score has the highest sensitivity and iMELD score has the strongest specificity.3.When MELD score,MELD-Na score,iMELD score,ABIC score,CTP score and CTP grade exceed the optimal cut-off value of 7.92,3.38,31.67,8.7,8 and B,respectively,the 24-month survival rate of patients can be predicted to be significantly reduced.4.The decrease of Cl~-level was an independent risk factor for death within 12months in ALC patients,and the increase of APTT level and MON were independent risk factors for death within 24 months in ALC patients.