Child-Pugh Scoring Query.

[ToHope]

Hi All,

I am concerned about the Child-Pugh scoring methodology and its application to patients with cirrhosis. This concern is probably due to my lacking a medical background, so with that in mind I am hoping someone in the know as it were could clear something up for me.

Given that the scoring calculation does not appear to take into consideration the presence or non-presence of liver harming conditions during the duration of the expected % of mortality, how can it be accurately applied to those of us (for example) with purely alcoholic cirrhosis who have stopped drinking? Or for those who have cirrhosis, but have cleared their HCV?

As an example of my confusion, take three people

a) Patient with Alcoholic Cirrhosis who no longer drinks who scores 9

b) Patient with Alcoholic Cirrhosis and drinks 50 units per week who scores 9

c) Patient with HCV and Cirrhosis who scores 9

d) Patient with cleared HCV and has remaining Cirrhosis who scores 9

Each can score a 9 at the point the test is performed based on the 5 constituent parameters, giving a 57% two year survival rate.

Based on this information alone, according to the CP scoring, the alcoholic liver disease patients probabilty of dying within 2 years remains the same - whether or not he or she continues to drink.

Likewise, the person with HCV and cirrhosis to a level of a score of 9 will also have a probability of dying which is equal to the person who has cleared their HCV but remains cirrhotic.

I feel, that the scores would be shifted (potentially) favourably for patients who cease alcohol or clear their HCV if the CP took into consideration the presence or non-presence of an on-going insult to the liver at the time of the test.

In other words, the 57% two year survival rate for a cirrhotic alcoholic who completely abstains from the point of the test onwards could raise to 80% maybe? (This is the crux of the question as opposed to a factual statement!!!)

I have to surmise that the averages and %'s are based on a mixture of ALL cirrhosis patients who do and do not stop drinking, and who have and have not cleared their HCV.

With this in mind (and if it is true), and not being aware myself of the proportionate values of patient "types" - I feel that the CP score offers me no real value as it currently stands, in determining my outlook.

Can anyone else explain it to me so that I am sure I understand it correctly.

[Hidden]

I think this is a question for specialists. There are a number of scoring mechanisms used in decision making in respect of transplant / allocation decisions (MELD, UKELD etc) and also assessment of quality of life years (QALYs). As you say, they offer no currency in determining your outlook and stand, as far as I can see, as a shorthand mechanism. I think you are left with the best option of getting a consultation with a specialist as soon as possible.

[Welshcake22]

What does HCV stand for please?

[AyrshireK]

HCV = Hepatitis C Virus