Predicting the prognosis of chronic liver disease: A comparision between Child – Pugh score and Model for end stage liver disease (MELD)

Background: It has been a great challenge for the physician to predict the prognosis and outcome of the chronic liver disease. Child-Pugh and MELD scores have been a widely used method for the assessment of prognosis in liver cirrhosis. Both used to determine the need for transplantation and also used to determine the effect of treatment on liver function. The combination of Child-Pugh and MELD score can guide patients and surgeons regarding operative risks. Aim and objective: To study and compare the clinical outcomes of patients with liver disease as predicted by Child – Pugh Scoring system, MELD Scoring system, to evaluate the prognostic accuracy of both (Child-Pugh Scoring System and MELD Scoring System). Materials and methods: The study was carried out at Vinayaka Mission's Medical College and Hospital, Karaikal among the patient population of the medicine ward who were diagnosed as having the chronic liver disease. This included 75 adult patients with the chronic liver disease who were either inpatients or those who reported for follow up as outpatients who were being managed on an ambulatory basis. All the selected patients were subjected to two scoring systems namely Child-Pugh Scoring and MELD Scoring Systems. The two scores derived from applying both the scoring system on each patient were compared and studied for predictive value and prognostic accuracy. Results: In our study, Correlation between Chid-Pugh Score and survival was -0.56 and correlation between MELD score and survival were -0.64. The following diagnostic indices were obtained: Child-Pugh Score: Sensitivity: 42%, Specificity: 78%. MELD Score: Sensitivity: 62%, Specificity: 87.5%. It was well observed that both scoring systems predict clinical outcome well, both scoring systems can be used to prognosticate survival in patients with Chronic Liver disease. However, it appeared that MELD Score is more accurate than the Chid-Pugh score for prognostic purposes. Conclusion: Pearson's Coefficient of correlation is closer to -1 for MELD Score as compared to Child-Pugh Score. MELD Score has a higher sensitivity and a higher positive predictive value as compared to Child-Pugh score. Hence MELD Score is a better and more accurate clinical scoring system for Chronic liver disease as compared to Child-Pugh score.