Other important prognostic variables The hepatorenal syndrome (HRS) – renal failure from renal arterial under-filling due to decompensated liver failure – portends a particularly poor prognosis. The formula to calculate MELD score is complex, and a calculator can be found at. An additional benefit over CTP is that it can predict prognosis on the order of months with more precision – making it helpful for determining hospice eligibility in the US. The MELD score relies on laboratory values alone (serum creatinine, total bilirubin, and INR). It is currently used to help determine organ allocation for liver transplantation, and there is increasing evidence that it can also be used generally to predict survival in patients with chronic liver failure. The Model for End-stage Liver Disease (MELD) score was developed in 2000 to overcome the above-mentioned limitations and determine survival benefit from transjugular intrahepatic portosystemic shunting. In addition, the scale does not include renal function, an important prognostic factor in liver failure. in grading ascites or encephalopathy) are its major limitations. Variations in the timing and subjectivity inherent in the scoring of the CTP (e.g.
Class C patients (10-15) have far greater mortality: 1-year median survival is 45% and 2-year is 38%. A score of 7-9 is considered Class B with median survivals of 80% at 1 year and 70% at two years. Patients scoring 5-6 points are considered to have ‘Class A’ failure their 1 and 2 year median survivals are 95% and 90%, respectively. Patients are grouped into three classes based on the total CTP score, which is simply the sum of the scores for each of the 5 variables. Of note, these indices predict prognosis for patients without liver transplantation. This Fast Fact reviews prognosis in chronic liver failure, focusing on two validated prognostic indices. After decompensation, median survival drops to ~ 2 years. Patients with compensated chronic liver failure (without ascites, variceal bleeding, encephalopathy, or jaundice) have a median survival of 12 years. Prognosis in Decompensated Chronic Liver Failureīackground In 2009, chronic liver disease and cirrhosis resulted in approximately 30,000 deaths, making it the twelfth leading cause of death in the United States.
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