Modified Child-Turcotte-Pugh score performs well in decompensated cirrhosis

A modified Child-Turcotte-Pugh (aCTP) score based on plasma ammonia (Amm) replacing hepatic encephalopathy (HE) improves discrimination and calibration of transplant-free survival in patients with decompensated cirrhosis, according to a study published online April 28 in QJM.

Xixuan Wang, from the Affiliated Drum Tower Hospital of Nanjing University Medical School in China, and colleagues examined the discrimination and calibration of a new prognostic model based on Amm replacing HE in the CTP score for patients with liver cirrhosis. The new model was based on the cutoff value of Amm-upper limit of normal (ULN) in an observational cohort of 554 patients with clinically stable cirrhosis from January 2012 to July 2019. The model was validated externally using prospective data from 185 patients with liver cirrhosis.

The researchers found a twofold increase in the likelihood of mortality with each 1-point increase in Amm-ULN (hazard ratio, 2.06). Amm-ULN <1.0 was given a score of 1, 1.0 to <1.4 was given a score of 2, and ≥1.4 was given a score of 3 in the aCTP score. Significant differences were seen in the survival curves among the three aCTP grades. Better agreements between predicted and observed events were seen in the validating cohorts for the aCTP score than the CTP score (C-statistics, 0.75 and 0.69, respectively). The aCTP score could predict acute decompensation and acute-on-chronic liver failure with C-statistics of 0.76 and 0.81, respectively.

"The generated aCTP score improves the discrimination and calibration of the CTP score by scoring the plasma ammonia index," the authors write. "However, further validation of a multicenter prospective cohort is needed."

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