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Published on: June 18, 2020

Assessment of prognosis of cirrhosis

François Durand1, Dominique Valla

  • 1Pôle des Maladies del' Appareil Digestif, Service d'Hépatologie, Université Paris VII, INSERM, U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, Hôpital Beaujon, Clichy, France. francois.durand@bjn.aphp.fr

Seminars in Liver Disease
|February 23, 2008
PubMed

Insights

The Child-Pugh score for cirrhosis prognosis has limitations. The Model for End-Stage Liver Disease (MELD) score offers a more objective assessment for liver disease severity and transplant prioritization.

Area of Science:

  • Hepatology
  • Clinical Prognostics
  • Transplantation Medicine

Background:

  • Cirrhosis decompensation significantly increases short-term mortality risk.
  • Liver transplantation has improved outcomes for decompensated cirrhosis patients.
  • The Child-Pugh score, a long-standing prognostic tool, suffers from subjective variable interpretation.

Purpose of the Study:

  • To evaluate the Model for End-Stage Liver Disease (MELD) score as a prognostic marker in cirrhosis.
  • To compare the objectivity and accuracy of MELD versus Child-Pugh score.
  • To assess MELD's utility in liver transplant candidate prioritization.

Main Methods:

  • Review of existing literature on cirrhosis prognostic scores.
  • Analysis of MELD score's objective variables (serum bilirubin, creatinine, INR).
  • Comparison of MELD and Child-Pugh score performance in predicting mortality and prioritizing transplants.

Main Results:

  • MELD score provides a more objective and continuous assessment of liver disease severity compared to Child-Pugh.
  • MELD score is a robust predictor of early mortality in various cirrhosis etiologies.
  • While MELD improves upon Child-Pugh, 10-20% of patients may still be misclassified, necessitating MELD exceptions.

Conclusions:

  • MELD score is a valuable tool for assessing cirrhosis prognosis and prioritizing liver transplant candidates.
  • The objectivity of MELD reduces subjective bias inherent in the Child-Pugh score.
  • Further research and specific approaches (MELD exceptions) are needed for comprehensive cirrhosis management.

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