Eligibility of the prognostic systems in assessing the severity of liver cirrhosis
Assessment of the severity of liver cirrhosis as a mandatory parameter includes a characteristic of the degree of its compensation. Detailed historical research has shown that this characteristic of liver disease has no authorship, no precise definition, and seems to be a matter of course for the medical community. Moreover, the term “decompensation” (the adjustment of certain functions due to the adaptation of other organs and systems) does not reflect the pathophysiology of changes developing in patients with terminal liver cirrhosis. When determining the degree of compensation for cirrhosis, physicians are forced to focus on the classification of Child and Turcotte in Pugh's modification. This system was developed to assess the outcome of surgical treatment of portal hypertension and validated to predict the survival of patients with liver cirrhosis (expectation of an event in the future) in the short and medium term, but cannot be correctly applied to assess the severity of liver cirrhosis (at the time of assessment). The inadequacy of the Child-Pugh prognostic system for assessing the severity of liver cirrhosis was shown by the example of determining the possibility of using HCV protease inhibitors in patients with complicated (“decompensated”) liver cirrhosis. It is necessary to develop new principles for assessing the severity of liver cirrhosis, in particular, in relation to the disorders of drug metabolism and the potential toxicity of drugs and their metabolites.