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Classification of Cirrhosis: The Child-Pugh score and The MELD (Model for End-stage Liver Disease) score

Klasifikasi Sirosis Hepatis

Multiple scores have been created to categorize the severity of disease. The Child-Pugh score is the most widely used. It incorporates three laboratory values (PT, bilirubin, and albumin) and two clinical features (ascites and encephalopathy). Class A patients have an 85% 2-year survival, compared with 60% and 35% for classes B and C, respectively.

The MELD (Model for End-stage Liver Disease) score has now supplanted the Child-Pugh classification for listing the patient for liver transplantation and is calculated by a formula that includes bilirubin, creatinine, and the INR instead of PT.

The Child-Pugh score
Bilirubin (mg/dL) <2.0 2.1–3.0 >3.0
Prothrombin time (seconds prolonged) <4 4–6 >6
Albumin (g/L) >3.5 2.8–3.5 <2.8
Ascites None Mild–moderate Severe
Encephalopathy None Mild–moderate Severe

Child's class A: 5–6
Child's class B: 7–9
Child's class C: 10–15

The MELD score 

MELD Score = 11.2 ln (INR) + 3.78 ln (bilirubin) + 9.57 ln (creatinine) + 6.43
<10 2%–8%
10–19 6%–29%
20–29 50%–76%
30–39 62%–83%
≥40 100%

Conn's Current Therapy 60th Edition (Saunders) 2008

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