What are the different liver evaluation scores besides the Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, and MELD-Na score?

Additional Liver Evaluation Scores Beyond Child-Pugh, MELD, and MELD-Na

Several validated prognostic scoring systems exist for liver disease assessment beyond the commonly used Child-Pugh, MELD, and MELD-Na scores, including UKELD, disease-specific models like the Mayo Risk Score for PSC, and specialized systems for hepatocellular carcinoma staging.

Disease-Specific Prognostic Models

Primary Sclerosing Cholangitis (PSC) Scoring Systems

Multiple prognostic models have been developed specifically for PSC patients, though none has emerged as a clear standard 1:

• Revised Mayo Natural History Model for PSC - The most widely used PSC-specific model, incorporating age, bilirubin, hemoglobin, and IBD status, though it has a complex formula reflecting the variable natural history of PSC 1

• Wiesner Score - Includes age, alkaline phosphatase, and histology as predictive parameters 1

• Farrant Score - Incorporates age, bilirubin, and histology to predict transplant need 1

• Broome Score - Uses age, alkaline phosphatase, and history of variceal bleeding to predict survival 1

• Ponsioen Score - Incorporates age and cholangiographic findings to predict survival 1

• Goode Score - Uses age and cholangiographic findings to predict death or need for transplantation 1

These PSC-specific models have limited role in ordinary patient care and are rarely used in UK clinical practice, serving mainly to assist in timing of liver transplantation and for research studies 1. The Child-Pugh score applied to PSC shows 7-year survival rates of 90%, 68%, and 25% for scores A, B, and C respectively 1.

UK Model for End-Stage Liver Disease (UKELD)

• UKELD is used in the United Kingdom for liver transplant allocation and may be applied to patients with PSC and other liver diseases 1

• Both MELD and UKELD may fluctuate highly and overestimate disease stage in PSC due to the impact of biliary obstruction on the bilirubin component 1

Hepatocellular Carcinoma (HCC) Staging Systems

Beyond liver function scores, several staging systems incorporate tumor characteristics 1:

• Okuda System - Incorporates both liver function parameters and tumor characteristics 1

• GRETCH (French Classification) - Includes Karnofsky performance score, liver function measurements, and serum AFP 1

• Chinese University Prognostic Index (CUPI) - Incorporates parameters from other staging systems plus additional variables 1

• AJCC TNM Staging System - Provides information on tumor characteristics only, without liver function assessment 1

Physiologic Assessment Tools

Hepatic Venous Pressure Gradient (HVPG)

• HVPG measures the pressure differential from portal to hepatic vein, providing a physiological readout integrating hemodynamic consequences of hepatic fibrosis 1

• HVPG is discussed as a potential surrogate endpoint "reasonably likely to predict clinical outcome" for accelerated drug approval 1

• Measurement of HVPG is an evolving tool for assessment of portal hypertension 1

Important Clinical Considerations

Portal Hypertension Assessment

An evaluation of clinically significant portal hypertension should be performed alongside any liver scoring system, as this is not adequately captured by Child-Pugh or MELD scores 1:

• Signs include esophagogastric varices, splenomegaly, abdominal collaterals, and thrombocytopenia 1

• Evidence may be visible on CT/MRI imaging 1

Renal Function Markers

• Blood urea nitrogen and creatinine are established prognostic markers in liver disease that should be assessed independently 1

• These are incorporated into MELD but not Child-Pugh scoring 1

Comparative Performance Notes

Limitations of Current Models

• No single prognostic method can be recommended at present to predict individual patient prognosis in PSC, given the unpredictable disease course 1

• Prognostic models using clinical and laboratory parameters for established PSC do not vary widely from data using the simple Child-Pugh score 1

• The superiority of MELD over Child-Pugh for predicting survival in cirrhotic patients not on transplant waiting lists remains unclear 1

Practical Application

For routine clinical practice, Child-Pugh and MELD/MELD-Na remain the primary tools, with disease-specific scores reserved for specialized populations or research settings 1. Given the serious nature of liver disease complications, patients should receive lifelong follow-up regardless of which scoring system is used 1.