title: Systematic review: The model for end-stage liver disease--should it replace Child-Pugh's classification for assessing prognosis in cirrhosis?
abstract: BACKGROUND
  Prognosis in cirrhotic patients has had a resurgence of interest because of liver transplantation and new therapies for complications of end-stage cirrhosis. The model for end-stage liver disease score is now used for allocation in liver transplantation waiting lists, replacing Child-Turcotte-Pugh score. However, there is debate as whether it is better in other settings of cirrhosis.
  
  
  OBJECTIVE
  To review studies comparing the accuracy of model for end-stage liver disease score vs. Child-Turcotte-Pugh score in non-transplant settings.
  
  
  RESULTS
  Transjugular intrahepatic portosystemic shunt studies (with 1360 cirrhotics) only one of five, showed model for end-stage liver disease to be superior to Child-Turcotte-Pugh to predict 3-month mortality, but not for 12-month mortality. Prognosis of cirrhosis studies (with 2569 patients) none of four showed significant differences between the two scores for either short- or long-term prognosis whereas no differences for variceal bleeding studies (with 411 cirrhotics). Modified Child-Turcotte-Pugh score, by adding creatinine, performed similarly to model for end-stage liver disease score. Hepatic encephalopathy and hyponatraemia (as an index of ascites), both components of Child-Turcotte-Pugh score, add to the prognostic performance of model for end-stage liver disease score.
  
  
  CONCLUSIONS
  Based on current literature, model for end-stage liver disease score does not perform better than Child-Turcotte-Pugh score in non-transplant settings. Modified Child-Turcotte-Pugh and model for end-stage liver disease scores need further evaluation.
authors.affiliation: Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, London, UK. cholongitas@yahoo.gr
authors.forename: E
authors.initials: E
authors.lastname: Cholongitas
authors.forename: G V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: M
authors.initials: M
authors.lastname: Vangeli
authors.forename: N
authors.initials: N
authors.lastname: Terreni
authors.forename: D
authors.initials: D
authors.lastname: Patch
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D001201:Ascites / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification*; D017093:Liver Failure / Q000145:classification*; D011379:Prognosis; D012720:Severity of Illness Index