Prognostic Evaluation of Decompensated Chronic Liver Disease: A Comparison Between CHIBA and MELD Scores

Raj K et al | DOI: 10.65188/nurexus.1021

Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 04 | April 2025

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Journal of MedVerse Research & Practice

nurexus.com

Prognostic Evaluation of Decompensated Chronic Liver Disease: A

Comparison Between CHIBA and MELD Scores

Dr. Kiran Raj

Professor

Department of Biochemistry, Government Medical College, Kanyakumari

Email: kiranraj83@gmail.com

Submission Date: 25.03.2025

Accepted Date: 20.04.2025

Published Date: 30.04.2025

DOI: 10.65188/nurexus.1021

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Decompensated chronic liver disease (DCLD) represents an advanced stage of liver dysfunction

characterized by complications such as jaundice, ascites, hepatic encephalopathy, and variceal bleeding. These

manifestations indicate a significant decline in liver function and contribute to increased mortality rates globally.

Materials and Methods: A hospital-based observational cohort study was carried out at Government Medical College

Hospital, Kannyakumari. The study involved 50 patients diagnosed with DCLD. Data were systematically collected,

recorded in Microsoft Excel, and analyzed using IBM SPSS Statistics version 27.

Results: Out of the 50 patients enrolled, 89% had a history of alcohol consumption, while 11% were smokers. The

mean Model for End-Stage Liver Disease (MELD) score was 22.0 ± 2.56, indicating a moderate degree of liver

dysfunction with minimal variability. In contrast, the mean CHIBA score was 12.9 ± 7.89, reflecting a broader range

of values. Statistical analysis revealed that both scoring systems were significant predictors (p < 0.001).

Conclusion: The CHIBA score demonstrated greater prognostic value compared to the MELD score in assessing

outcomes in patients with decompensated chronic liver disease. However, further multicentric studies and prospective

validations are necessary to confirm its clinical applicability.

Keywords: CHIBA score, MELD score, Decompensated Chronic Liver Disease, Prognosis, Liver Dysfunction

Introduction

Decompensated chronic liver disease (DCLD) signifies an advanced and critical phase of liver dysfunction,

often marked by serious complications such as jaundice, ascites, hepatic encephalopathy, and variceal

bleeding [1]. These clinical manifestations reflect a significant decline in hepatic function and are linked

with increased mortality rates globally. The etiological factors contributing to DCLD differ across regions;

however, the global burden, particularly due to non-alcoholic fatty liver disease (NAFLD), is on the rise and

poses a major public health concern [2,3].

Given the high fatality rate associated with DCLD, there is a pressing need for accurate prognostic tools that

can guide clinical management and help prioritize candidates for liver transplantation. Traditional scoring

systems such as the Model for End-Stage Liver Disease (MELD), its modified versions, and the Child-

Turcotte-Pugh (CTP) score have been extensively utilized for mortality risk assessment. Nonetheless, these

models have certain shortcomings and may not always provide optimal predictive accuracy [4,5].

The CHIBA score - an acronym for Creatinine, Hepatic Encephalopathy, International Normalized Ratio

Raj K et al | DOI: 10.65188/nurexus.1021

Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 04 | April 2025

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(INR), Bilirubin, and Ascites - has recently been introduced as an alternative prognostic tool for DCLD. It

relies on routinely collected clinical signs and laboratory results, allowing for easy calculation and

applicability even in resource-constrained healthcare environments [6].

The CHIBA scoring system is designed to enhance the prediction of clinical outcomes in patients with

DCLD, offering a potentially more practical and precise alternative to existing models like MELD and CTP.

By depending on widely available data, it may support improved risk stratification, aid in clinical decision-

making, and better identify patients in urgent need of liver transplantation [7,8]. The emergence of the

CHIBA score represents a notable advancement in the assessment of prognosis in advanced liver disease.

Nonetheless, further research and external validation are necessary to establish its reliability and to

benchmark its performance against established scoring systems [9,10].

The primary aim of this study is to evaluate the effectiveness of the CHIBA score in predicting clinical

outcomes in patients with decompensated chronic liver disease (DCLD). This study seeks to assess the

diagnostic accuracy of the CHIBA score and determine its utility as a reliable prognostic tool. Additionally,

the objective includes a direct comparison between the CHIBA score and the widely used MELD score to

establish which model offers better predictive performance in assessing disease severity and mortality risk in

patients with DCLD.

Materials & Methods

Study Design and Setting: This hospital-based observational cohort study was conducted at the

Government Medical College Hospital, Kanyakumari, over three months. The study aimed to evaluate the

clinical profile, biochemical parameters, and short-term outcomes of patients diagnosed with decompensated

chronic liver disease (DCLD).

Study Population: A total of 50 patients with a confirmed diagnosis of DCLD were enrolled. Patients aged

18 years or older who presented to the Departments of General Medicine and Emergency Medicine were

included after meeting the eligibility criteria.

Inclusion Criteria

• Adults aged >18 years.

• Clinically and biochemically confirmed diagnosis of DCLD, based on standard criteria (e.g., ascites,

jaundice, coagulopathy, hepatic encephalopathy, or imaging evidence of cirrhosis).

• Willingness to provide written informed consent for participation and follow-up.

Exclusion Criteria

• Patients with hepatocellular carcinoma or extrahepatic malignancies.

• Those with secondary metastases to the liver.

• Patients listed for liver transplantation within the next three months.

• Individuals who refused consent or had incomplete clinical data.

Data Collection: Upon admission, detailed clinical and demographic information was recorded using a

structured proforma. The following parameters were assessed:

• Demographic data: age, sex, and occupation.

• Clinical parameters: presence of jaundice, ascites, hepatic encephalopathy, pedal edema, and other

signs of liver failure.

• Etiological factors: alcohol intake, viral hepatitis markers, and comorbidities.

• Biochemical parameters: serum bilirubin, creatinine, international normalized ratio (INR), serum

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albumin, liver enzymes, and electrolytes.

Clinical Assessments: The presence and severity of ascites were determined both clinically and through

imaging modalities (ultrasound or CT scan). Ascites was graded as:

• Absent/mild: Score 0

• Moderate: Score 1

• Tense: Score 2

Hepatic encephalopathy (HE) was assessed clinically and graded according to the West Haven criteria,

ranging from Grade I (mild confusion) to Grade IV (coma).

The Model for End-Stage Liver Disease (MELD) score was calculated using standard laboratory values of

serum bilirubin, serum creatinine, and INR, using the formula:

MELD Score = 3.78 × ln⁡(bilirubin) + 11.2 × ln⁡(INR) + 9.57 × ln⁡(creatinine) + 6.43

(Values below 1 were adjusted to 1 for logarithmic calculation.)

Laboratory Investigations: Venous blood samples were collected under aseptic precautions on the day of

admission. Laboratory estimations were carried out using standardized methods in the hospital’s

biochemistry laboratory:

• Serum creatinine: measured by Jaffe’s kinetic method.

• Serum bilirubin: estimated using the colorimetric diazo method on a Hitachi Roche Cobas c311

analyzer.

• INR: measured through an automated clotting method using a Sysmex coagulation analyzer.

Follow-Up: All patients were prospectively followed up for a period of three months from the date of

admission. Clinical progress, development of complications (such as hepatic encephalopathy, spontaneous

bacterial peritonitis, hepatorenal syndrome, or gastrointestinal bleed), and survival status were documented

during follow-up visits or telephonic contact.

Statistical Analysis: All data were entered into Microsoft Excel and analyzed using SPSS version 26.0

(IBM Corp., Armonk, NY, USA). Descriptive statistics such as mean, standard deviation, median, and

percentage were used to summarize the baseline data. Comparisons between groups were made using the

Chi-square test for categorical variables and the independent t-test or Mann–Whitney U test for continuous

variables, based on data distribution. The correlation between MELD score and clinical or laboratory

parameters was assessed using Pearson’s or Spearman’s correlation test. A p-value of less than 0.05 was

considered statistically significant. Results were expressed as mean ± standard deviation (SD) or as

frequency and percentage and presented in tables and charts for clarity.

Ethical Considerations: The present study was approved by the Institutional Ethics Committee of

Government Medical College, Kanyakumari (Ref No: EC/GMC-KK/54219). A detailed Participant

Information Sheet was provided to all participants, and written informed consent was obtained prior to their

enrollment in the study.

Results

This is a hospital-based observational cohort study that was conducted in 50 patients with decompensated

chronic liver disease.

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Table 1: Age distribution among the DCLD patients

Age

Frequency (n)

Percentage (%)

< 30 years

31 – 40 years

10%

41 – 50 years

24%

51. – 60 years

28%

>60 years

34%

The age distribution among patients with Decompensated Chronic Liver Disease (DCLD). It shows that the

highest proportion of patients are over 60 years old, accounting for 34% of the total. The youngest group,

under 30 years old, represents the smallest portion at 4%. This distribution indicates that DCLD is more

prevalent among older individuals.

Figure 1: Details of clinical features

The prevalence of various symptoms in patients with Decompensated Chronic Liver Disease (DCLD).

Abdominal swelling is the most common symptom, reported by 95% of patients, followed by weight loss

(89%) and leg swelling (73%). Malaise affects 65% of patients, while Meleana (black, tarry stools) and

hematemesis (vomiting blood) are reported by 66% and 56% of patients, respectively. These findings

illustrate the diverse and often severe symptomatology associated with DCLD, underscoring the need for

comprehensive clinical management.

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Figure 2: Details of complications

The prevalence of various clinical features among patients with Decompensated Chronic Liver Disease

(DCLD) is shown in chart 2. Ascites is the most common complication, affecting 22.5% of the patients.

Jaundice follows, impacting 20% of the patients, while 18.5% experienced bleeding varices.

Encephalopathy, which includes symptoms such as confusion, affects 17% of the patients.

Figure 3: Details on personal history

The prevalence of two behaviors among a group of individuals. It shows that 89% of the individuals are

alcoholics, while only 11% are smokers.

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Table 2: General characteristics of study population

Variables

Mean and Standard deviation

Height

163.5±12.6

Weight

86±5.36

BMI

29±3.6

Waist circumference

107±11.11

SPO2

97±2.54

Pulse rate

72±8.66

Systolic blood pressure (SBP)

110.24±5.44

Diastolic blood pressure (DBP)

69.12±2.19

The general characteristics of the study population is given in the above table. The average height is 163.5

cm, and the average weight is 86 kg. The mean Body Mass Index (BMI) is 29.

Table 3: Baseline variables of the study population

Variables

Mean and

Standard deviation

P value

Hemoglobin

10.2 ± 1.5

0.001

Serum creatinine

1.8 ± 0.7

0.000

Total bilirubin

4.5 ± 1.2

0.002

INR

2.1 ± 0.4

0.000

SGOT

85 ± 25

0.000

SGPT

75 ± 20

0.011

ALP

140 ± 35

0.02

The mean hemoglobin level is 10.2 g/dL; Serum creatinine is 1.8 mg/dL. Total bilirubin has a mean of 4.5

mg/dL. Lastly, the mean ALP is 140 U/L.

Table 4: Mean of MELD and CHIBA Score

Score

Mean and

P value

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Standard deviation

MELD

22.0±2.56

0.01

CHIBA

12.9±7.89

0.000

The severity of liver disease in a sample of patients with Decompensated Chronic Liver Disease (DCLD).

The mean MELD score is 22.0±2.56, reflecting a moderately severe condition with relatively low variability

among the patients. The mean Child-Pugh (CHIBA) score is 12.9±7.89, indicating more variability in

disease severity. The CHIBA score is more important when compared to the MELD score. (Table 4)

Discussion

This study provides a comparative evaluation of the CHIBA and MELD scores in predicting the prognosis of

patients with decompensated chronic liver disease (DCLD), offering important insights into their relative

performance. Both scores demonstrated statistically significant prognostic capabilities, with certain notable

distinctions. The findings of the present study are consistent with those reported by Kim et al., who

demonstrated that the MELD score is a reliable predictor of short-term mortality in patients with advanced

liver disease [2]. The strength of the MELD score lies in its objective nature, as it is derived from laboratory

parameters such as serum creatinine, total bilirubin, and INR, which reflect hepatic and renal function. In the

current cohort, the MELD score showed consistent predictive validity, particularly in identifying patients at

increased risk of short-term mortality.

Despite these strengths, the limitations of the MELD score have been widely discussed in the literature. It

does not account for important clinical complications such as ascites and hepatic encephalopathy, which are

hallmark features of DCLD and significantly influence prognosis. This limitation is addressed by the CHIBA

score, which incorporates both biochemical and clinical parameters, including ascites and the severity of

hepatic encephalopathy. Similar observations were reported by Zhang et al., who noted that the CHIBA

score improves prognostic accuracy in selected patient populations, especially where clinical manifestations

play a dominant role [1].

The clinical relevance of integrating biochemical and clinical variables has also been highlighted by Sharma

et al., who demonstrated improved sensitivity in predicting early decompensation and mortality among

patients with cirrhosis when such combined models are used [3]. In the present study, the CHIBA score

showed predictive accuracy comparable to that of the MELD score, suggesting that it may serve either as a

complementary tool or a practical alternative, particularly in resource-limited settings where frequent

laboratory testing may not be feasible.

Furthermore, Udompap et al. emphasized that prognostic scores incorporating functional or symptomatic

parameters often better reflect the patient’s current clinical status, especially in acute or unstable settings [4].

This supports the present findings and suggests that routine use of the CHIBA score may provide a more

holistic assessment of disease severity in patients with DCLD.

From a clinical perspective, the results support a tailored application of prognostic scoring systems. While

the MELD score remains indispensable, particularly for liver transplant prioritization, the inclusion of

clinical parameters in the CHIBA score may enhance risk stratification and facilitate more individualized

patient management. Tapper et al. also reported that integrating real-time clinical data with prognostic

scoring systems improves bedside decision-making, underscoring the potential utility of the CHIBA model

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in routine practice [5].

In addition, this study highlights the need for ongoing refinement of prognostic models in chronic liver

disease. Given the dynamic nature of DCLD, static scoring systems may not fully capture rapid clinical

deterioration. Future models may benefit from incorporating additional parameters such as serum sodium

levels, inflammatory markers, or liver stiffness measurements. Advances in machine learning and artificial

intelligence have also been proposed as promising tools for developing adaptive prognostic models, as

discussed by Wong et al. [6].

In conclusion, both MELD and CHIBA scores provide valuable prognostic information in patients with

DCLD. Their complementary use may offer a more comprehensive assessment of disease severity and

mortality risk. Further multicentric prospective studies with larger sample sizes are required to validate these

findings and optimize the clinical application of these prognostic tools.

Conclusion

The CHIBA score shows potential as an alternative prognostic tool to the MELD score in evaluating patients

with decompensated chronic liver disease. By integrating key clinical features alongside biochemical

markers, it offers a more holistic view of disease severity. Nonetheless, its broader applicability and

effectiveness need to be confirmed through validation in varied patient groups and healthcare environments.

Future investigations should emphasize prospective designs and direct comparative analyses to better clarify

the clinical value and positioning of the CHIBA score in routine practice.

Conflict of Interest: Nil

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