Systematic review: The model for end-stage liver disease--should it replace Child-Pugh's classification for assessing prognosis in cirrhosis?
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.
Cholongitas
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E
Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, London, UK. cholongitas@yahoo.gr
Papatheodoridis
G V
GV
Vangeli
M
M
Terreni
N
N
Patch
D
D
Burroughs
A K
AK
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