Comparing MELD-3 and Child-Pugh Scores in Predicting 90-Day Readmission and Mortality in Patients with Liver Cirrhosis.

Abstract

Objective: This comparative analysis aims to quantify the superior predictive performance of MELD-3 relative to Child-Pugh scores and to evaluate its implications for clinical decision-making and resource allocation in patients with liver cirrhosis.
Methodology: This prospective observational study was performed at the Department of Medicine, Dr. Ruth. K. M. Pfau, Civil Hospital, Karachi, Dow University of Health Sciences, from May 2025 to November 2026. 250 patients of decom-pensated cirrhosis of >18 years meeting the inclusion/ exclusion criteria were included. The data collection consisted of demographic information, and blood samples were taken, and scores were calculated at discharge and readmission within 3 months on a pre-designed proforma. Data analysis was done by using SPSS 25, and descriptive statistics were applied.
Results: Among 250 hospitalized patients, 20 (8%) died, and 230 (92%) survived. The mean Child-Pugh Score (CPS) increased from 8.68 ±1.92 at discharge to 9.87 ±2.06 at readmission. While the mean MELD 3.0 score rose from 17.83 ±8.10 to 21.00 ±9.26. Mortality was significantly associated with CPS at discharge (mean difference 1.27, p=0.004) and readmission (mean difference 1.87, p<0.001), as well as MELD-3 at discharge (mean difference 7.47, p<0.001) and re-admission (mean difference 5.05, p=0.019). Logistic regression analysis identified CPS at readmission, MELD-3 at dis-charge and readmission, and CPS class as independent predictors of mortality.
Conclusion: CPS, particularly at readmission, demonstrated slightly better predictive accuracy, while MELD-3 remains a useful adjunct. A combined or dynamic approach may provide the most clinically meaningful risk stratification.
Key words: MELD 3, CPS, Decompensated Cirrhosis, mortality.