The Predictive Values Of The Meld And Child-Pugh Scores In Determining Mortality From Chronic Liver Disease Patients In Anambra State, Nigeria.

Background: Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide with differing aetiology in different geographic regions. The Child-Pugh’s (C-P) and Model for end-stage liver disease (MELD) scores are important determinants of severity and prognosis in CLD. We aimed to compare the predictability values of these scores in determining short-term mortality in a cohort of CLD patients in Anambra state, South-east, Nigeria. Method: This was a prospective study in two hospitals in Anambra state, Nigeria. A total of 112 subjects with CLD were recruited from September 2007 to May 2008 and were followed-up for three months to determine outcome (death or survival) at the end of this period. The C-P as well as the MELD score of each patient was calculated on enrolment. Results: Of the 112 patients recruited into the study, 60(54%) had HCC, 46(41%) had liver cirrhosis and 6(5%) had chronic hepatitis. Only 106 patients completed the study while 6 were lost to follow-up. Of those who completed the study, 70(66%) died and 36(34%) survived. HCC and liver cirrhosis comprised 48(69%) and 22(31%) of the non-survivors and both were associated with mortality (p=0.000). In multivariate analysis, the MELD and CP scores were both independent predictors of 3-month mortality(p<.001). The AUROC for the MELD score was 0.827 (95% CI 0.746-0.907). It was superior to that of C-P score which was 0.777 (95% CI 0.689-0.864). Conclusion: The C-P and MELD scores are valid predictors of short-term mortality from CLD irrespective of aetiology, however, the MELD performed better than the C-P score.