Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD

Child-Pugh classification has been a reference for more than 30 years for assessing the prognosis of cirrhosis. MELD score comes as the most serious challenger for replacing Child-Pugh score and overcoming its limitations. The principal advantages of MELD score are that (a) it is based on variables selected by statistical analysis rather than clinical judgement, (b) the variables are objective and unlikely to be influenced by external factors, (c) each variable is weighted according its proper influence on prognosis and (d) the score is continuous which helps scoring individuals more precisely among large populations. However, MELD score also has limitations including the need for computation, the absence of clearly defined cut-off values for categorizing cirrhotic patients and the absence of validation in some clinical situations. In addition, despite its theoretical advantages MELD score did not prove universally superior to Child-Pugh score in the setting of liver graft allocation and survival after TIPS. MELD score is superior to Child-Pugh for management and comparisons at a population level. Nonetheless, for the assessment of individuals at the bedside, it can be anticipated that Child-Pugh will resist as an almost intuitive score which can be combined easily with other clinical information. © 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.