CRP Level Predicts Short-Term Mortality Better Than MELD Score in End-Stage Liver Disease: Presented at AASLD

By Cheryl Lathrop

BOSTON -- November 3, 2010 -- In patients with end-stage liver disease (ESLD), the C-reactive protein (CRP) level predicts short-term mortality better than, and independently of, the Model for End-Stage Liver Disease (MELD) score, researchers said here at the 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

This is important because the determination of patients with the highest risk of mortality is crucial to optimise the allocation of liver grafts, according to Jean-Paul Cervoni, MD, Service d'Hépatologie, CHU Jean Minjoz, Besançon, France, and colleagues.

The occurrence of systemic inflammatory response syndrome (SIRS) was reported to affect the survival of patients with ESLD, but it is not considered by the MELD score. The aim of this study was to improve the prediction of short-term mortality in patients with ESLD by evaluating CRP as a possible surrogate marker of SIRS.

This was a prospective study of 155 consecutive cirrhotic patients with a Child-Pugh score >8, admitted between January 2007 and June 2010. The median age of the patients was 58 years; 86% were male; 83% had alcoholic cirrhosis; 42% had a comorbidity; 29% had SIRS; 15.5% had hepatocellular carcinoma; the median MELD score was 22.5; the median CRP was 26.5 mg/L; and the median procalcitonin was 0.28 ng/mL.

The researchers recorded 170 demographic, clinical, biochemical, and histological variables at admission, and during follow-up on day 15, month 3, and month 6. The primary endpoint was survival at month 3.

The following key events occurred during follow-up (median 2.9 months): 41% got a bacterial infection, 7% had hepatorenal syndrome, 8% had a liver transplant, 26% died at month 3, and 30% died at month 6.

The 3-month survival according to CRP level was as follows: >100 mg/L, 0%; 70 to 100 mg/L, 59%; 40 to 70 mg/L, 64%; 10 to 40 mg/L, 75% and <10 mg/L, 87%.

Variables associated with month 3 mortality were hepatocellular carcinoma, extrahepatic carcinoma, a high MELD score, a high CRP level (>26 mg/L), elevated blood lactate, and renal failure. Variables associated with month 3 mortality were a high CRP level (>26 mg/L), the MELD score, extrahepatic comorbidities, and hepatocellular carcinoma.

Multivariate analysis identified 3 predictors of mortality: extrahepatic comorbidities (P =.021), a high CRP level (P =.013), and MELD score (P =.023). The performance of the 3 variables taken together for predicting death was 0.74 (Area Under the Receiver Operating Characteristic [AUROC]). The performance of the MELD score was 0.61 (AUROC), and the performance of the CRP level alone for the same prediction was 0.66 (AUROC) -- better than the performance of the MELD score.

"This finding suggests that we should build a new MELD-CRP prognosis score," said Dr. Cervoni on November 1.

[Presentation title: CRP Predicts Short-Term Mortality in Patients With End-Stage Liver Disease (ESLD) Independently of MELD Score: A Prospective Study. Abstract 1209]

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