Patients with compensated chronic liver failure (without ascites, variceal bleeding, encephalopathy, or jaundice) have a median survival of 12 years. After decompensation, median survival drops to ~2 years.
Validated prognostic indices for patients without liver transplantation provide objective guidance to prognostication in liver failure.
Childs-Turcotte-Pugh(CTP) calculator. It relies on encephalopathy, ascites, bilirubin, albumin, and international normalized ratio. Patients are grouped into three classes based on the total CTP score, which is the sum of the scores for five variables. Patients scoring:
- 5-6 points (Class A failure): 1- and 2-year median survivals are 95% and 90%, respectively.
- 7-9 points (Class B failure): 1- and 2-year median survivals are 80% and 70%, respectively.
- 10-15 points (Class C failure): 1- and 2-year median survivals are 45% and 38 %, respectively.
The CTP calculator can be found at https://www.hepatitisc.uw.edu/page/clinical-calculators/ctp
Model for End-Stage Liver Disease (MELD) score. The MELD score relies on laboratory values alone (serum creatinine, total bilirubin, and INR); it can predict prognosis with more precision. The MELD calculator can be found at https://reference.medscape.com/calculator/meld-score-end-stage-liver-disease
Other important prognostic variables
- Hepatorenal syndrome (HRS), renal failure from renal arterial under-filling due to decompensated liver failure, means a particularly poor prognosis.
- Older age and hepatocellular carcinoma adversely affect survival.
See reference for more information. Adapted from Dolan B and Arnold R. Prognosis in decompensated chronic liver failure. Palliative Care Network of Wisconsin. Fast facts and concepts #189. Internet. Accessed on April 28, 2018.