Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 995-1006
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.995
Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy
Shi-Lan Wu, Yi-Xiang Zheng, Zheng-Wen Tian, Meng-Shi Chen, Hong-Zhuan Tan
Shi-Lan Wu, Zheng-Wen Tian, Meng-Shi Chen, Hong-Zhuan Tan, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
Yi-Xiang Zheng, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410000, Hunan Province, China
Author contributions: Wu SL contributed to the study inception and design, literature search and selection, data acquisition, and analysis and writing of the manuscript; Zheng YX contributed to the study inception, literature selection, and data analysis and discussion; Tian ZW contributed to the literature search and selection, language editing, and manuscript revision; Chen MS contributed to the quality assessment and manuscript revision; Tan HZ contributed to the study design, manuscript revision, and study supervision; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Zhuan Tan, PhD, Professor, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410000, Hunan Province, China. tanhz99@qq.com
Telephone: +86-731-88858435 Fax: +86-731-84805454
Received: September 14, 2018
Peer-review started: September 14, 2018
First decision: November 1, 2018
Revised: November 8, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 6, 2018
Processing time: 84 Days and 10.6 Hours
Abstract
AIM

To compare the accuracy of the scoring systems Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease score (MELD), MELD-Na, and MELD to Serum Sodium ratio (MESO) to predict the mortality in decompensated liver cirrhosis.

METHODS

The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4.

RESULTS

Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves (AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81, 0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELD-Na at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively.

CONCLUSION

MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELD-Na has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.

Keywords: Liver cirrhosis; Decompensated; Mortality; Accuracy; Meta-analysis

Core tip: Liver cirrhosis, especially decompensated liver cirrhosis, is a common chronic disease that is also the leading cause of death among nonmalignant diseases worldwide. The poor survival of decompensated cirrhosis has pushed doctors to find more accurate prognostic scoring systems to recognize and manage patients. No meta-analysis has focused on comparison of the prediction accuracy for those patients in the past. This study aimed to compare the test accuracy of four systems [Child-Turcotte-Pugh, Model for End-Stage Liver Disease score (MELD), MELD-Na, and MELD to Serum Sodium ratio] quantitatively and to pinpoint the more reliable scoring system for forecasting the mortality of decompensated liver cirrhosis patients clinically.