From the Guidelines
Several scoring systems exist for assessing hepatic disease severity and prognosis, including the Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na score, Maddrey's Discriminant Function, GAHS (Glasgow Alcoholic Hepatitis Score), NAFLD Fibrosis Score, FIB-4 index, and APRI (AST to Platelet Ratio Index) 1.
Scoring Systems for Hepatic Disease
The Child-Pugh score evaluates bilirubin, albumin, prothrombin time/INR, ascites, and hepatic encephalopathy to classify cirrhosis into classes A, B, and C with increasing severity 1.
- The MELD score uses bilirubin, creatinine, and INR to predict short-term mortality and prioritize liver transplantation candidates 1.
- The MELD-Na score incorporates serum sodium for improved accuracy.
- For alcoholic hepatitis, the Maddrey's Discriminant Function and GAHS help determine treatment necessity 1.
- The NAFLD Fibrosis Score assesses fibrosis risk in non-alcoholic fatty liver disease using age, BMI, diabetes status, AST/ALT ratio, platelet count, and albumin.
- The FIB-4 index uses age, AST, ALT, and platelet count to evaluate fibrosis.
- The APRI serves as a simpler alternative for fibrosis assessment.
Clinical Application
These scoring systems guide clinical decision-making, treatment selection, transplant prioritization, and prognosis estimation in various liver diseases 1.
- The albumin-bilirubin grade model is another helpful tool to assess liver dysfunction, especially in predicting the survival outcome of patients with stable decompensated cirrhosis 1.
- The development of ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepatorenal syndrome also have a significant impact on the prognosis of patients with cirrhosis 1.
From the Research
Scoring Systems for Hepatic Disease
The following scoring systems exist for assessing the prognosis of hepatic disease:
- Child-Pugh score: a widely used scoring system that assesses the prognosis of cirrhosis based on factors such as bilirubin, albumin, and prothrombin time 2, 3, 4, 5, 6
- Model for End-Stage Liver Disease (MELD) score: a scoring system that predicts the severity of liver disease and mortality risk based on factors such as serum creatinine, serum bilirubin, and international normalization ratio (INR) of prothrombin time 2, 3, 4, 5, 6
- Modified MELD scores: such as MELD-Na and Delta MELD, which have been developed to address the limitations of the original MELD score 2, 5
- Albumin-Bilirubin (ALBI) score: a scoring system that has been shown to be useful in predicting short-term outcomes in patients with decompensated cirrhosis 5
- Integrated MELD (iMELD) score: a scoring system that combines the MELD score with other factors to predict mortality risk in patients with liver cirrhosis 5
Comparison of Scoring Systems
Studies have compared the performance of these scoring systems in predicting mortality and prognosis in patients with hepatic disease:
- The MELD score has been shown to be an excellent predictor of survival in cirrhotic patients, at least as well as the Child-Pugh score 6
- The ALBI score has been shown to be particularly useful in assessing short-term outcomes in patients with decompensated cirrhosis 5
- The MELD score has been shown to be particularly useful in assessing long-term outcomes in patients with decompensated cirrhosis 5
- The Child-Pugh score and MELD score have been shown to be comparable in predicting prognosis in patients with liver cirrhosis and esophageal variceal bleeding 6