Research article

A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

Constantinos Chatzicostas¹ , Maria Roussomoustakaki¹ , Georgios Notas² , Ioannis G Vlachonikolis³ , Demetrios Samonakis¹ , John Romanos⁴ , Emmanouel Vardas¹ and Elias A Kouroumalis^1,2

¹Department of Gastroenterology, University Hospital, Heraklion, Crete, Greece

²Liver Research Laboratory, University of Crete Medical School, Greece

³Biostatistics Laboratory, University of Crete Medical School, Greece

⁴Department of Surgical Oncology, University Hospital, Heraklion, Crete, Greece

author email corresponding author email

BMC Gastroenterology 2003, 3:7doi:10.1186/1471-230X-3-7

Published:	8 May 2003

Abstract

Background

The aim of this study was to assess the prognostic accuracy of Child-Pugh and APACHE II and III scoring systems in predicting short-term, hospital mortality of patients with liver cirrhosis.

Methods

200 admissions of 147 cirrhotic patients (44% viral-associated liver cirrhosis, 33% alcoholic, 18.5% cryptogenic, 4.5% both viral and alcoholic) were studied prospectively. Clinical and laboratory data conforming to the Child-Pugh, APACHE II and III scores were recorded on day 1 for all patients. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test.

Results

Overall mortality was 11.5%. The mean Child-Pugh, APACHE II and III scores for survivors were found to be significantly lower than those of nonsurvivors. Discrimination was excellent for Child-Pugh (ROC AUC: 0.859) and APACHE III (ROC AUC: 0.816) scores, and acceptable for APACHE II score (ROC AUC: 0.759). Although the Hosmer-Lemeshow statistic revealed adequate goodness-of-fit for Child-Pugh score (P = 0.192), this was not the case for APACHE II and III scores (P = 0.004 and 0.003 respectively)

Conclusion

Our results indicate that, of the three models, Child-Pugh score had the least statistically significant discrepancy between predicted and observed mortality across the strata of increasing predicting mortality. This supports the hypothesis that APACHE scores do not work accurately outside ICU settings.