Child-Pugh Score for Cirrhosis Mortality
Child-Pugh score: Estimates cirrhosis severity.
West Haven Criteria: Defines criteria for the stages of hepatic encephalopathy.
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Grade 0: normal consciousness, personality, neurological examination, electroencephalogram
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Grade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves
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Grade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves
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Grade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves
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Grade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity
MELD score: Determines prognosis and prioritizes receipt of liver transplantation.
Original MELD Score = (0.957 * ln(Serum Cr) + 0.378 * ln(Serum Bilirubin) + 1.120 * ln(INR) + 0.643) * 10
If on hemodialysis, the value for Creatinine is automatically set to 4.0.
MELD-Na score: Determines prognosis and prioritizes receipt of liver transplantation.
Adds sodium to the MELD model for liver cirrhosis.
MELD Score = (0.957 * ln(Serum Cr) + 0.378 * ln(Serum Bilirubin) + 1.120 * ln(INR) + 0.643) * 10
If on hemodialysis, the value for Creatinine is automatically set to 4.0.
MELD-Na = MELD Score - Na - 0.025 × MELD × (140-Na) + 140
Sodium is limited within the range of 125 to 140; if it falls outside these limits, it is adjusted to the nearest limit.
MELD-Na score (UNOS/OPTN)
Quantifies end-stage liver disease for transplant planning with sodium.
Candidates aged 12 and older receive an initial MELD(i) score calculated as follows:
MELD(i) = 0.957 × ln(Cr) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643
Round the score to the tenth decimal place and multiply by 10.
If MELD(i) > 11, calculate the additional MELD score:
MELD = MELD(i) + 1.32 × (137 – Na) – [ 0.033 × MELD(i) × (137 – Na) ]
Key Rules:
- Use U.S. units: Cr and bilirubin in mg/dL, Na in mEq/L, and INR is unitless.
- Set any value of bilirubin, Cr, or INR below 1.0 to 1.0.
- Use Cr = 4.0 if:
- Cr > 4.0,
- ≥2 dialysis treatments in the last 7 days, or
- 24 hours of CVVHD in the last 7 days.
- Use Na = 125 if <125, and Na = 137 if >137.
- Maximum MELD score is 40.
MELD 3.0
Candidates who are at least 18 years old at the time of registration receive an initial MELD score calculated using the following formula:
MELD 3.0 = 1.33*(Female) + 4.56*ln(Serum bilirubin) + 0.82*(137 - Sodium) – 0.24*(137 - Sodium)*ln(Serum bilirubin) + 9.09*ln(INR) + 11.14*ln(Serum creatinine) + 1.85*(3.5 – Serum albumin) – 1.83*(3.5 – Serum albumin)*ln(Serum creatinine) + 6
Candidates who are currently between 12 and 17 years old and were under 18 at the time of registration receive a MELD score calculated as follows:
MELD 3.0 = 4.56*ln(Serum bilirubin) + 0.82*(137 - Sodium) – 0.24*(137 - Sodium)*ln(Serum bilirubin) + 9.09*ln(INR) + 11.14*ln(Serum creatinine) + 1.85*(3.5 – Serum albumin) – 1.83*(3.5 – Serum albumin) – 1.83*(3.5 – Serum albumin)*ln(Serum creatinine) + 7.33
Please note the following adjustments and limitations for the input values:
- Serum Bilirubin, INR, and Serum Creatinine values below 1.0 are set to 1.0.
- Sodium levels are limited to a range of 125-137 mEq/L. If the value falls outside this range, it is adjusted to the nearest limit.
- Serum Albumin levels are limited to a range of 1.5-3.5 g/dL. If the value is outside this range, it is adjusted to the nearest limit.
Additionally, the following candidates will receive a fixed creatinine value of 3.0 mg/dL:
- Those with a creatinine value greater than 3.0 mg/dL.
- Those who have received two or more dialysis treatments within 7 days prior to the serum creatinine test.
- Those who have undergone 24 hours of continuous veno-venous hemodialysis (CVVHD) prior to the serum creatinine test.
Finally, the MELD 3.0 score is rounded to the nearest integer.
Result
5 Scores
Child Class A
Life Expectancy: 15-20 years
One-year survival rate: 100%
Abdominal surgery peri-operative mortality: 10%
References
Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85. PMID: 4950264.
Bailey, C. (2010). Hepatic Failure : An Evidence-Based Approach In The Emergency.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70. doi: 10.1053/jhep.2001.22172. PMID: 11172350.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008 Sep 4;359(10):1018-26. doi: 10.1056/NEJMoa0801209. PMID: 18768945; PMCID: PMC4374557.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70. doi: 10.1053/jhep.2001.22172. PMID: 11172350.