Systematic review: the model for end‐stage liver disease – should it replace Child‐Pugh's classification for assessing prognosis in cirrhosis?

Summary Background: Prognosis in cirrhotic patients has had a resurgence of interest because of liver transplantation and new therapies for complications of end‐stage cirrhosis. The model for end‐stage liver disease score is now used for allocation in liver transplantation waiting lists, replacing Child‐Turcotte‐Pugh score. However, there is debate as whether it is better in other settings of cirrhosis. Aim: To review studies comparing the accuracy of model for end‐stage liver disease score vs. Child‐Turcotte‐Pugh score in non‐transplant settings. Results: Transjugular intrahepatic portosystemic shunt studies (with 1360 cirrhotics) only one of five, showed model for end‐stage liver disease to be superior to Child‐Turcotte‐Pugh to predict 3‐month mortality, but not for 12‐month mortality. Prognosis of cirrhosis studies (with 2569 patients) none of four showed significant differences between the two scores for either short‐ or long‐term prognosis whereas no differences for variceal bleeding studies (with 411 cirrhotics). Modified Child‐Turcotte‐Pugh score, by adding creatinine, performed similarly to model for end‐stage liver disease score. Hepatic encephalopathy and hyponatraemia (as an index of ascites), both components of Child‐Turcotte‐Pugh score, add to the prognostic performance of model for end‐stage liver disease score. Conclusions: Based on current literature, model for end‐stage liver disease score does not perform better than Child‐Turcotte‐Pugh score in non‐transplant settings. Modified Child‐Turcotte‐Pugh and model for end‐stage liver disease scores need further evaluation.