How do you predict life after diagnosis of cirrhosis?

Cirrhosis is the commonly known name for liver disease. Cirrhosis is the medical term for a shrunken and scarred liver. It is the common end point of many diseases. Cirrhotic livers have varying ability to cope with the metabolic demands - denoted by the medical term compensation. The first decision to do is to find out how long can the patient live after the diagnosis of cirrhosis.

The ability of the liver to cope will reflect how long the patient will survive from the liver disease in the next 2 - 5 years. 

Research in the last decade has given us a few numbers that predict how long the patient has to survive with liver disease.

Let us look at a few important numbers.

This graph is the classic study on how patients with a diagnosis of cirrhosis will live and die over a period of 5 years. The green line, which denotes cirrhosis with no decompensation (inability to cope with metabolic demands) shows a 60% survival at 5 years. The blue line indicates when the liver is showing signs of failure or decompensation or inability to cope with the metabolic demands and this line shows 50% of the patients are dead by 24 months and only 15% survive at 5 years.

The above graph gives a visual idea about 2 year and 5 year survivals. To know this prediction, one has to know whether the patient has a decompensated disease. Decompensation is noted by presence of jaundice, fluid in the belly (ascites), blood vomiting (GI bleed), confusion and mental disturbances (Encephalopathy), kidney damage (Hepatorenal syndrome) and lung problems.

Look at the data below. In 1964, 2 doctors devised a scale for measuring how patients survive at 1 year after diagnosis of cirrhosis. This score is still used today by some doctors during treatment of cirrhosis

The second set of numbers is the Child score. We use this number to denote to distinguish survival at 1 and 2 years.  Using simple tests for liver function and the presence of fluid in the belly and confusion, we arrive at the number. CTP C class has a high risk of death - 55% of the patients will be dead by 1 year, if they have Child C disease.

If you want to predict whether the patient will survive the next 3 months, the MELD score is the best method to predict 3 month survival. It is so accurate that the American Transplant Centers and UNOS, which is the administrative body for transplant uses this number to allocate the liver for recipients. The Red line shows that at MELD 32, 33, 50% of the patients will die at 3 months. The orange line shows at at MELD score of 15 or more, the patients start to die from the liver disease.
This MELD score of 15 is chosen as the number at which patients will need liver transplantation to survive.

The last number that I would like you to learn is the MELD number, which includes one more component now called the MELD Sodium score. When the number crosses 30, there is a very high chance that the patient may die during the next 3 months. In India, we are seeing more and more cirrhotic patients die even at MELD scores of 22 and above. This is because Indian patients have become weak and are unable to withstand the serious complications from cirrhosis.

At MELD of 20, patients are constantly hospitalised and have a very slim chance of survival without liver transplantation.

Parts of the MELD score are illustrated and using online calculators, one can arrive at the number for the patient.

So whenever a diagnosis of cirrhosis is made, the patient and the family must ask these questions:

1. Do I have decompensated liver disease?
2. Do I have Child B or Child C disease?
3. What is my MELD score?

If, on the basis of the discussion above, you find yourself at high risk of death, find out whether you are fit to undergo a liver transplantation. If you can undergo a liver transplantation, this will provide you with the best survival and you can fight the odds and have another round of great life.