Inclusion of hepatic encephalopathy adds additional prognostic value to the MELD score. The MELD score is a valid prognostic score for intermediate term mortality in a heterogeneous population with chronic liver disease although the CTP score is equivalent in predicting survival. The proportion of patients that developed AKI was lower in the post MELD era (p 0.04), although renal replacement therapy requirement was more frequent in this group (p < 0.01). Hepatic encephalopathy was a strong independent predictor of death (Hazard ratio-2.8, P<0.0001). Eight hundred seventy-four patients were included, 408 in pre-MELD and 466 in the post MELD era. The CTP score had similar predictive abilities as the MELD. The MELD score was a good predictor of 1-year mortality in chronic liver disease (c-statistics for all subgroups >/=0.75) and of 3- and 6-month mortality in alcoholic hepatitis (c-statistic >/=0.83). A multivariable model was constructed to examine predictors of mortality. Receiver operating characteristic (ROC) curves was used to compare the MELD and CTP score. Observed and predicted survival curves were plotted to evaluate the predictive ability of the MELD score for survival. One thousand six hundred and eleven patients with chronic liver disease were studied. We studied and compared the predictive abilities of the MELD score and the Child-Turcotte-Pugh (CTP) score for intermediate (1-year) and long-term (5-year) mortality. The utility of the model for end stage liver disease (MELD) score in non-transplant patients, particularly in those with less severe chronic liver disease remains uncertain.
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