Recalibrating the Child–Turcotte–Pugh Score to Improve Prediction of Transplant-Free Survival in Patients with Cirrhosis View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-11

AUTHORS

David E. Kaplan, Feng Dai, Melissa Skanderson, Ayse Aytaman, Michelle Baytarian, Kathryn D’Addeo, Rena Fox, Kristel Hunt, Astrid Knott, Rajni Mehta, Marcos Pedrosa, Christine Pocha, Adriana Valderrama, Tamar Taddei, for the VOCAL Study Group

ABSTRACT

BACKGROUND: The 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. OBJECTIVE: The objective of this study was to identify evidence-based cutpoints for the CTP laboratory subscores to improve its predictive capacity for transplant-free survival. DESIGN: Retrospective observational study. DATA SOURCE: Using 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. RESULTS: Modification 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. CONCLUSION: We 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. More... »

PAGES

3309-3320

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10620-016-4239-6

DOI

http://dx.doi.org/10.1007/s10620-016-4239-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1047480801

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27405990


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