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02/10/2011 05:32 PM

Child-Pugh Score & MELD Score Calculators

TamieJP
TamieJPPosts: 2324
Senior Member

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02/11/2011 06:34 AM
carm
 
Posts: 101
Member

What is the difference between child-pugh score and meld score? I am so confused. I hope he is doing alright. Thanks so much.

02/11/2011 04:16 PM
TamieJP
TamieJPPosts: 2324
Senior Member

Just from reading the NET, I have decided that the Child-Pugh score helps one determine the STAGE of cirrhosis.

The MELD score is called (Model For End-Stage Liver Disease) and is used to determine when a person is ready for transplant.


02/11/2011 06:25 PM
bjlvls
bjlvls  
Posts: 1013
Senior Member

So many of us have had the same question Carm, what's the difference between a Meld and a CTP score. Gail has always explained it this way:

Before the MELD score was adopted to determine where you were placed on the transplant list they used the CTP score to determine a "stage" so they could determine a "status" for placement.There are many Child-Pugh Calculators out there on the web but I have found that Gail's website has the easiest to understand explanation of the Child-Pugh system and how it works. See her writings at:

http://www.livingwithcirrhosis.weebly.com/

On the menu listed at the left of the page, scroll to diagnosis and tests, then click on “Your CTP Score”

Dennis has an entry that you should read,(or re-read Smile ) as well, which will help to clarify this matter.

I get the feeling that some of us are getting hung up on MELD scores! Let's recap again what MELD represents. Everyone, even "healthy, normal, people" have a MELD as its basis in in the results of three blood tests as others have pointed out. As the liver starts to fail, the blood test results change thus changing the MELD's base value. Additional adjustments to the MELD occur based on additional conditions of the patient. These include, but are not limited to, things like portal vein thrombosis (PVT) or hepatocellular carcinoma (HCC, aka liver cancer). I believe there is a bias depending on the type of liver disease. MELD values indicate the patient's relative health: the higher the value, the sicker the patient.

When organs become available, they are evaluated (tested) to see if they are viable and establish the criterion for matching to the pool of patients that have been placed on the waiting list. All patients with matching criteria form an actual list ranked by the patient's current MELD value. The organ becomes available to the patient with the best matching criteria based on rules set by the United Network for Organ Sharing (UNOS). UNOS is the private, non-profit organization that manages the nation's organ transplant system under contract with the federal government. Some of the rules involve proximity between the candidate recipient and the organ donor as time is a critical factor to successful transplantation. The rules also allow for some leeway in some of the matching criteria depending on the condition of the organ and the MELD of individuals on the candidate donor list.

Mostly, your MELD score is irrelevant in terms of your overall health--at best it gives you a relative value of how close you are getting to the point of transplant. Don't get hung up on trying to use your MELD to determine how sick you are.

Dennis

To see his original post, go to his profile page, and look under discussions and click on MELD.

THE Meld calculator used by UNOS (United Network for Organ Sharing) and OPTN (Organ Procurement and Transplantation Network) is here:

http://optn.transplant.hrsa.gov/resources/ MeldPeldCalculator.asp?index=98

(That's the same reference Tam gave us.)

These are the organizations through which all organ transplants in the entire United States of America are determined.

The Mayo Clinic also has an up-to-date Meld calculator found at:

http://www.mayoclinic.org/meld/mayomodel6.html

Mayo also has a Meld model that Medical Professionals use to factor in low sodium levels for the possibility of leveling the playing field for those patients suffering low sodium, but UNOS will still ultimately make the final determination. Here's that one:

http://www.mayoclinic.org/meld/mayomodel8.html

I hope this clears some things up for you. - B -

Post edited by: bjlvls, at: 02/11/2011 06:27 PM


02/11/2011 06:47 PM
carm
 
Posts: 101
Member

Thanks, B - its alot to handle. When I figured it out, its a 20 for the meld, 9 for the child-pugh. I think its high. The doctor said that some of the numbers were better this time, though, and some stayed the same. This is such a roller coaster. I try to stay in the moment and be positive. It is sometimes difficult - easier to shut down. I appreciate your response. I needed to re read the websites you mentioned. It made me feel better to know that someone can fluctuate between compensated and decompensated liver. I guess I feel better now, thx -

Post edited by: carm, at: 02/11/2011 06:48 PM

Post edited by: carm, at: 02/11/2011 06:52 PM


02/17/2011 02:45 PM
TamieJP
TamieJPPosts: 2324
Senior Member

Hope I'm not driving people crazy but thought this article might interest some.

Do Chronic Liver Disease Scoring Systems Predict Outcomes in Trauma Patients With Liver Disease? A Comparison of MELD and CTP

Abstract

Background: Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. Currently, data regarding the use of CTP in trauma is limited, whereas MELD remains unstudied. We compared MELD and CTP to determine which scoring system is a better clinical outcome predictor after trauma.

Methods: A review of trauma admissions during 2003–2008 revealed 68 patients with chronic liver disease. Single and multiple variable analyses determined predictors of hepatic complications and survival. MELD and CTP were compared using odds ratios and area under the receiver operating curve (AUC) analyses. A p value ≤0.05 was significant.

Results: The mean MELD and CTP scores of the population were 13.1 ± 6.0 and 8.3 ± 1.8, respectively (mean ± SD). Overall, 73.5% had one or more complications and 29.4% died. When survivors were compared with nonsurvivors, no difference in mean MELD scores was found, although mean CTP score (survivors, 7.7 ± 1.5; nonsurvivors, 9.4 ± 1.9; p = 0.001) and class (“C” survivors, 12.1%; “C” nonsurvivors, 56.3%; p = 0.002) were different, with survival relating to liver disease severity. Odds ratios and AUC determined that MELD was not predictive of hepatic complications or hospital survival (p > 0.05), although both CTP score and class were predictive (p < 0.05; AUC > 0.70).

Conclusion: Trauma patients suffering from cirrhosis can be expected to have poorer than predicted outcomes using traditional trauma scoring systems, regardless of injury severity. Scoring systems for chronic liver disease offer a more effective alternative. We compared two scoring systems, MELD and CTP, and determined that CTP was the better predictor of hepatic complications and survival in our study population.

http://journals.lww.com/jtrauma/Abstract/2010/09000/ Do_Chronic_Liver_Disease_Scoring_Systems_Predict.14.aspx

Edited to add link.

Post edited by: TamieJP, at: 02/18/2011 11:07 AM


02/14/2012 08:04 PM
wdstkdrgnfly
wdstkdrgnfly  
Posts: 62
Member

how can you have a MELD score of 14 for 2 years and then suddenly you are told it is 4? Is this really possible being in grade 3 stage 4 cirrhosis???

02/14/2012 08:37 PM
mikealpha1
mikealpha1  
Posts: 2287
Group Leader

I'm thinking the 4 is probably stage 4, i.e. cirrhosis. (that's a surprise, right? ha)

02/14/2012 08:55 PM
ruth8890
ruth8890  
Posts: 1181
Senior Member

Not to change the MELD subject from wdstkdrgnfly but WOW Marg and Mike - I'm having one of those terrible stomach, gas, bloating days and had a lot of dental work done on top of that today. I was feeling so great yesterday, darn it. So... I was reading your messages about the whey protein powder and didn't even know my brother has a 2 lb container in the kitchen! I just ate cereal with banana slices and the powder mix + 2% milk and it was awesome! What a miracle to stumble on what you were talking about. Hope others will try it. So healthy and like a comfort food. Bon appetit Smile Ru

02/15/2012 10:36 AM
sadlystillsane
sadlystillsane  
Posts: 942
Member

That whey powder with soy milk for me has been a lifesaver. It gives me healthy protein and usually I can still get it down when I feel awful. Glad you found some right at home!! Smile
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