What are the stages of cirrhosis?

There are different systems to help categorize the severity of liver cirrhosis, including the Child-Pugh score and the MELD (model of end-stage liver disease) score.

Child-Pugh score

In the 1960s, Child and Turcotte developed a classification system for cirrhosis patients, which was then modified in the 1970s by Pugh to create the Child-Pugh scoring system.²

The Child-Pugh score looks at the following five criteria (click on each one to find out more):²

• Ascites
• Hepatic encephalopathy
• Blood albumin levels
• Blood bilirubin levels
• Blood clotting time (called the International Normalized Ratio)

Depending on severity, each of these criteria is given a score between 1 and 3, and then all the scores are added together to give a total score, which is then used to give the patient a Child-Pugh grade:²

Child-Pugh grades²

• Child-Pugh-A (total number 5 to 6): good liver function
• Child-Pugh-B (total number 7 to 9): moderate liver function
• Child-Pugh-C (10 to 15 points total): poor liver function

The higher the score, the worse the prognosis is for the patient.²

The MELD-Score

The MELD system is useful in helping healthcare teams to prioritize patients with end-stage liver disease who are waiting for a liver transplant. It is calculated by measuring various blood values, such as sodium levels, bilirubin levels and creatinine levels.³

A MELD scores helps to determine the risk of a patient dying in the next three months, also known as the three-month mortality risk, unless they have a liver transplant. For example, a patient with a MELD score less than 9 would have a 1.9% risk of dying in the next three months, whereas a patient with a MELD score greater than 40 would have a 71.3% risk of dying.³

Patient with higher MELD scores can be moved higher up on the waiting list for a life-saving liver transplant that could extend their life for years.³