What are Duke's criteria, Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, and Maddrey's discriminant function?

From the Guidelines

Duke's criteria, MELD score, Child-Pugh score, and Maddrey score are important clinical scoring systems used to assess different medical conditions, with the MELD score being the most recent and widely used system for evaluating liver disease severity, as evidenced by the 2021 study 1.

Overview of Scoring Systems

• Duke's criteria helps diagnose infective endocarditis by evaluating major criteria (positive blood cultures, echocardiographic evidence of endocardial involvement) and minor criteria (fever, predisposing heart conditions, vascular phenomena).
• The MELD (Model for End-Stage Liver Disease) score predicts three-month mortality in patients with liver disease using bilirubin, creatinine, INR, and sodium levels, with scores ranging from 6 to 40 (higher scores indicating worse prognosis) 1.
• The Child-Pugh score assesses liver function and prognosis in cirrhosis by measuring bilirubin, albumin, INR, ascites, and encephalopathy, classifying patients into classes A, B, or C with increasing severity 1.
• Maddrey's Discriminant Function specifically evaluates alcoholic hepatitis severity using prothrombin time and bilirubin; a score above 32 indicates severe disease with high mortality, typically warranting corticosteroid treatment (prednisolone 40mg daily for 28 days) 1.

Clinical Application

These scoring systems guide clinical decision-making for diagnosis, treatment, and organ allocation priorities based on objective measurements of disease severity. For example, the MELD score is used to stratify patients on the liver transplantation waiting list according to their risk of death within 3 months 1. The Child-Pugh score is used to assess the severity of liver disease and predict survival in patients with cirrhosis 1. Maddrey's Discriminant Function is used to evaluate the severity of alcoholic hepatitis and guide treatment decisions 1.

Recommendation

The MELD score should be used as the primary scoring system for evaluating liver disease severity, due to its widespread adoption and validation in recent studies 1. Additionally, the Maddrey Discriminant Function should be used to stratify patients with alcoholic hepatitis, as recommended by the 2010 study 1.

From the Research

Duke's Criteria

• Duke's criteria are a set of clinical criteria used for the diagnosis of infective endocarditis (IE) 2, 3, 4, 5, 6
• The criteria utilize clinical, microbiologic, and echocardiographic data to diagnose IE
• Duke's criteria have been shown to be more sensitive than the von Reyn criteria in diagnosing IE, with a sensitivity of up to 100% 3

Model for End-Stage Liver Disease (MELD) Score

• There is no information available in the provided studies regarding the MELD score

Child-Pugh Score

• There is no information available in the provided studies regarding the Child-Pugh score

Maddrey's Discriminant Function

• There is no information available in the provided studies regarding Maddrey's discriminant function

Limitations of Duke's Criteria

• Despite the high sensitivity of Duke's criteria, some patients with IE may remain misclassified, particularly those with culture-negative IE or Q-fever IE 6
• Prior antibiotic therapy and negative blood cultures can limit the diagnostic value of Duke's criteria 6