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अमूर्त

Prognostic Models in Cirrhosis: An Anesthetist Perspective

Chandra K Pandey and Vandana Saluja

There has been an increase in the number of patients suffering from liver disease who present for surgery/noninvasive procedures in diverse clinical scenarios and non transplant settings. Risk estimation and prognostication, therefore, becomes very important for the anaesthetist who will encounter such patients in different clinical settings. The knowledge of merits and demerits of various prognostic models is necessary. Apart from estimation of the life expectancy, these models also tell us about the ability of these patients to withstand a particular procedure or whether the therapeutic option offers an acceptable chance of survival. Improved care in the critical care setting has also enabled many patients with decompensated liver disease to undergo liver transplantation successfully.
Presently prognostication mainly involves the CTP (Child Turcotte Pugh) and MELD (Modification of End Stage Liver Disease) scores. Various attempts have been made to modify them to overcome the shortcomings of the original scores. Knowledge of merits and demerits of each score is essential for appropriate prognostication. However in the critical care setting the ICU scores have been found to be better indicators of mortality. The SOFA (Sequential organ failure assessment) score has been recently modified for critically ill patients with liver disease.
In this review article, we have attempted to summarise the various prognostic scoring systems for risk stratification of patients with liver disease.