Assessment of Prognosis of Cirrhosis

[Guest guest]

http://www.thieme-connect.com/ejournals/abstract/sld/doi/10.1055/s-2008-1040325

Semin Liver Dis 2008; 28: 110-122DOI: 10.1055/s-2008-1040325

Assessment of Prognosis of Cirrhosis

François Durand1, Dominique Valla1

1 Pôle des Maladies del' Appareil Digestif, Service d'Hépatologie, Université Paris VII, INSERM, U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, Hôpital Beaujon, Clichy, France

ABSTRACT

Once patients with cirrhosis experience decompensation, early mortality risk increases sharply. Liver transplantation has transformed the prognosis of decompensated cirrhosis. Child-Pugh score has been the reference for many years for assessing the prognosis of cirrhosis. However, Child-Pugh score has important limitations among which is subjective interpretation of some of its variables, making it difficult to categorize patients according to their own disease severity. The model for end-stage liver disease (MELD) score, which was originally designed for assessing the prognosis of cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), is a continuous score relying on three objective variables. Along with TIPS, MELD score proved to be a robust marker of early mortality across a wide spectrum of causes of cirrhosis, even though 10 to 20% of patients are still misclassified. MELD is especially useful for prioritizing candidates for transplantation according to a “sickest first” policy. However, MELD is not a universal prognostic marker of cirrhosis and several MELD exceptions require more specific approaches.

KEYWORDS

Cirrhosis - MELD score - Child score - portal hypertension - liver transplantation