Sunday November 12, 2006
Assessment of cirrhosis !! - Part 3 - CPS vs MELD score
Editors' note: This is 3rd pearl in series to assess prognosis in cirrhosis. See
Part 1 - The Child-Turcotte-Pugh score (CPS) here and
Part 2 - "model for end stage liver disease" (MELD) score here
Many experts believed that Child-Pugh score to allocate liver for transplantation was subject to misjudgement due to level of clinical subjectiveness for ascites and hepatic encephalopathy. Also, there were public allegations that liver allocation is not transparent and fair. In february, 2002 a new method for allocating livers for transplantation, known as the Model for End-Stage Liver Disease (MELD) score, is institutated to leave no room for subjective criteria favoritism, as it was based on a mathematical equation. The equation calculates a patient’s likelihood of dying within three months and measures the level of sickness. In other words, the sickest patient gets the liver transplant.
Since than many attempts have been made to compare both the score but literature failed to prove superiority of MELD over CP score. They both have their own strengths and weaknesses.The overall trend at this point and take home message is to keep using the CP score for individual assessment of liver disease in daily clinical practice. And, the MELD score in prioritizing candidates for liver transplant.
We are putting here a reference article comparing both scores.
Systematic Review: The Model for End-Stage Liver Disease - Should it Replace Child-Pugh's Classification for Assessing Prognosis in Cirrhosis? - Aliment Pharmacol Ther. 2005;22(11):1079-1089. Available via free registration with medscape.com
Another good reference article is Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD - Journal of Hepatology Volume 42, Issue 1, Supplement 1, April 2005, Pages S100-S107 but is subject to subscription.
We are thankful to Dr. Richard Saval, Associate Director, Surgical Intensive Care Unit, Maimonides Medical Center and Assistant Professor of Medicine, Mt. Sinai School of Medicine, NY in helping us out in this series of pearl.
Assessment of cirrhosis !! - Part 3 - CPS vs MELD score
Editors' note: This is 3rd pearl in series to assess prognosis in cirrhosis. See
Part 1 - The Child-Turcotte-Pugh score (CPS) here and
Part 2 - "model for end stage liver disease" (MELD) score here
Many experts believed that Child-Pugh score to allocate liver for transplantation was subject to misjudgement due to level of clinical subjectiveness for ascites and hepatic encephalopathy. Also, there were public allegations that liver allocation is not transparent and fair. In february, 2002 a new method for allocating livers for transplantation, known as the Model for End-Stage Liver Disease (MELD) score, is institutated to leave no room for subjective criteria favoritism, as it was based on a mathematical equation. The equation calculates a patient’s likelihood of dying within three months and measures the level of sickness. In other words, the sickest patient gets the liver transplant.
Since than many attempts have been made to compare both the score but literature failed to prove superiority of MELD over CP score. They both have their own strengths and weaknesses.The overall trend at this point and take home message is to keep using the CP score for individual assessment of liver disease in daily clinical practice. And, the MELD score in prioritizing candidates for liver transplant.
We are putting here a reference article comparing both scores.
Systematic Review: The Model for End-Stage Liver Disease - Should it Replace Child-Pugh's Classification for Assessing Prognosis in Cirrhosis? - Aliment Pharmacol Ther. 2005;22(11):1079-1089. Available via free registration with medscape.com
Another good reference article is Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD - Journal of Hepatology Volume 42, Issue 1, Supplement 1, April 2005, Pages S100-S107 but is subject to subscription.
We are thankful to Dr. Richard Saval, Associate Director, Surgical Intensive Care Unit, Maimonides Medical Center and Assistant Professor of Medicine, Mt. Sinai School of Medicine, NY in helping us out in this series of pearl.
posted by icupearls.org archive | 6:28 PM
|
1 Comments
