Do Chronic Liver Disease Scoring Systems Predict Outcomes in Trauma Patients With Liver Disease? A Comparison of MELD and CTP

作者：Seamon Mark J^*; Franco Michael J; Stawicki S Peter; Smith Brian P; Kulp Heather; Goldberg Amy J; Santora Thomas A; Gaughan John P

来源：Journal of Trauma-Injury Infection and Critical Care, 2010, 69(3): 568-573.

DOI：10.1097/TA.0b013e3181ec0867

• Chronic liver disease
• Cirrhosis
• Scoring systems
• Outcome predictors

Background: Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. Currently, data regarding the use of CTP in trauma is limited, whereas MELD remains unstudied. We compared MELD and CTP to determine which scoring system is a better clinical outcome predictor after trauma.
Methods: A review of trauma admissions during 2003-2008 revealed 68 patients with chronic liver disease. Single and multiple variable analyses determined predictors of hepatic complications and survival. MELD and CTP were compared using odds ratios and area under the receiver operating curve (AUC) analyses. A p value <= 0.05 was significant.
Results: The mean MELD and CTP scores of the population were 13.1 +/- 6.0 and 8.3 +/- 1.8, respectively (mean +/- SD). Overall, 73.5% had one or more complications and 29.4% died. When survivors were compared with nonsurvivors, no difference in mean MELD scores was found, although mean CTP score (survivors, 7.7 +/- 1.5; nonsurvivors, 9.4 +/- 1.9; p = 0.001) and class ("C" survivors, 12.1%; "C" nonsurvivors, 56.3%; p = 0.002) were different, with survival relating to liver disease severity. Odds ratios and AUC determined that MELD was not predictive of hepatic complications or hospital survival (p > 0.05), although both CTP score and class were predictive (p < 0.05; AUC > 0.70).
Conclusion: Trauma patients suffering from cirrhosis can be expected to have poorer than predicted outcomes using traditional trauma scoring systems, regardless of injury severity. Scoring systems for chronic liver disease offer a more effective alternative. We compared two scoring systems, MELD and CTP, and determined that CTP was the better predictor of hepatic complications and survival in our study population.

• 出版日期2010-9