From the Guidelines
The MELD score is superior to the Child-Pugh score for predicting short-term mortality and determining transplant priority, as it uses objective laboratory values and has a more sensitive dynamic range. The Child-Pugh score and MELD score are both important tools for assessing liver disease severity, but they differ in several key aspects. The Child-Pugh score uses five clinical measures: bilirubin, albumin, prothrombin time/INR, ascites, and hepatic encephalopathy, classifying patients into classes A, B, or C with increasing severity 1. It's relatively simple to calculate and provides a general assessment of liver function and cirrhosis severity. The MELD score, on the other hand, uses only three objective laboratory values: bilirubin, creatinine, and INR, resulting in a numerical score from 6 to 40 1.
Some key points to consider when using these scores include:
- The MELD score is particularly valuable for predicting short-term mortality and is the primary system used for liver transplant prioritization in many countries 1.
- While Child-Pugh incorporates clinical judgment for ascites and encephalopathy assessment, MELD relies solely on laboratory values, making it more objective but potentially missing some clinical aspects of liver dysfunction.
- Child-Pugh may be more useful for general clinical assessment and treatment decisions, while MELD is superior for predicting short-term survival and determining transplant priority.
- The MELD score has a more sensitive dynamic range than the Child-Pugh score and is used to determine organ allocation for liver transplantation 1.
- A MELD score > 14 is typically the minimal listing threshold for transplantation, and a score > 15 with a minimal 2-point change from baseline may be used as a surrogate endpoint in clinical trials 1.
In practice, physicians often use both scoring systems to get a comprehensive picture of a patient's liver disease severity, as recommended by recent guidelines 1.
From the Research
Comparison of Child-Pugh and MELD Scores
- The Child-Pugh score and the Model for End-Stage Liver Disease (MELD) score are two commonly used systems to assess the severity of liver disease 2, 3, 4, 5, 6.
- The Child-Pugh score is based on five clinical parameters: albumin, bilirubin, prothrombin time, ascites, and encephalopathy, while the MELD score is calculated using three laboratory parameters: bilirubin, creatinine, and international normalized ratio (INR) 2, 3.
Predictive Value of Child-Pugh and MELD Scores
- Studies have shown that both scores have predictive value for mortality in patients with liver cirrhosis, but the MELD score may be more accurate in predicting short-term mortality 2, 4, 6.
- The MELD score has been shown to be superior to the Child-Pugh score in predicting intermediate-term outcome in patients with advanced cirrhosis 2.
- However, other studies have found that the Child-Pugh score remains a simple and effective tool for prognostic assessment of cirrhotic patients and can still be used in clinical practice 4.
Factors Associated with Increasing MELD Score
- Ascites and hepatic encephalopathy have been significantly associated with increasing MELD score 2.
- The change in MELD score over time (DeltaMELD) may have additional prognostic value and has been shown to be superior to initial MELD and Child-Pugh scores in predicting outcome in patients with advanced cirrhosis 2.
Clinical Applications of Child-Pugh and MELD Scores
- Both scores are used to prioritize patients awaiting liver transplantation, with the MELD score being used in the United States and the Child-Pugh score being used in other countries 3, 5.
- The MELD score has been shown to be an excellent survival predictor in cirrhotic patients, at least as well as the Child-Pugh score, and can identify patients with a higher intrahospital mortality risk due to esophageal variceal bleeding 6.