Editing Cirrhosis (section)

== Prognosis ==

* Child-Pugh classification was originally developed to assess risk of non-shunt operations in patients with cirrhosis
** 1-year mortality of 0%, 20% and 55% for A, B and C respectively
** Mortality rate after abdominal surgery
*** A 10%
*** B 30%
*** C 70-80%
** Scoring
*** Score of 5-15
*** 5-6 = CPA
*** 7-9 = CPB
*** 10-15 = CPC
** Breakdown
*** 1, 2 or 3 points for each category
*** Ascites: Absent, slight, moderate
*** Bili: <35, 36-51, >51
*** Albumin: >35, 28-35, <28
*** INR: <1.7, 1.7-2.3, >2.3
*** Encephalopathy: None, Grade 1 or 2, grade 3 or 4
* MELD (Model for End-stage Liver Disease)
** Determines prognosis and prioritises liver transplant allocation
** Versions
*** Original MELD
*** MELD-Na (2016)
*** MELD 3.0 (2022) - swap out ascites and encephalopathy for sodium and creatinine levels
**** Creatinine level (receive max value if on dialysis)
**** Bilirubin level
**** INR
**** Sodium level
**** Albumin level

* Elective surgery well tolerated in CP-A or MELD <10
* Might be able to optimise a CP-B/MELD 10-15 to safety
* All surgery contraindicated in CP-C/MELD >15
** Only if there is no other option, and should be clearly informed about their high mortality risk