Which Prognostic Tool to Use for Assessing the Prognosis of Cirrhosis?
Child-Pugh score has been the reference for assessing the prognosis of cirrhosis for about three decades. The longevity of the Child-Pugh score can be explained by its empirical simplicity, its intuitiveness, and, overall, its good accuracy across a broad spectrum of causes and specific situations. In recent years, MELD score emerged as a “modern” alternative to Child-Pugh score. There is no clear evidence that MELD is superior to Child-Pugh score in terms of accuracy. Studies comparing these scores have shown that the accuracy of Child-Pugh score for predicting 3-month to 3-year survival is not always inferior (and is sometimes even slightly superior) to that of MELD score. In addition, for many physicians, Child-Pugh score remains more convenient to use at the bedside and more explicit than MELD score.
However, MELD score has several strengths compared with Child-Pugh. The variables incorporated into the MELD score are simple and more objective. The weight of each variable has been determined by statistical analysis. MELD is a continuous score, which makes it more convenient for scoring individuals within large populations. In addition to organ allocation, MELD score has been validated across a large spectrum of causes of liver diseases. All these reasons make the MELD score likely to be the core tool for assessing the prognosis of cirrhosis in the future. By using MELD score, it can be reasonably assumed that physicians will get landmarks as simple as those they had with Child-Pugh score.
However, as indicated above, the outcome of cirrhosis is quite variable from patient to patient according to different causes, different stages, and different therapeutic options. In parallel, with the expansion of MELD score, several “MELD exceptions” emerged. Therefore, the quest for a universal, simple, and objective scoring system for cirrhosis is likely to remain unsuccessful. As many as 11 different scores mentioned above are available for addressing general or more specific issues regarding the prognosis of cirrhosis ( Table 2 , Table 3 , and Table 4 ). Other scores which are not mentioned or detailed in this article have been proposed. This assortment is confusing. Again, MELD score could represent a core system. However, it is not a universal prognostic marker of liver diseases. Adjustments of MELD score and/or the adjunction of additional variables are needed to address some specific issues. More studies are needed to create adapted MELD score derivates.
While patients with decompensated cirrhosis are exposed to severe complications, short-term and middle-term mortality in patients with compensated cirrhosis is very low. Predicting decompensation is more relevant than predicting mortality in this group. Prognostic tools for predicting decompensation would be useful.
Semin Liver Dis. 2008;28(1):110-122. © 2008 Thieme Medical Publishers
Cite this: Assessment of Prognosis of Cirrhosis - Medscape - Feb 01, 2008.