Aim <p>This study aims to compare the effectiveness of the model for end-stage liver disease (MELD), the modified model for end-stage liver disease including sodium (MELD-Na), and the Child–Pugh score (CPS) in predicting complications in patients with cirrhosis.</p> Methods <p>We conducted a prospective and observational study, analyzing 145 cirrhotic patients admitted to a tertiary care teaching hospital. The predictive accuracies of MELD, MELD-Na, and CPS for complications such as ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, varices, hepatocellular carcinoma, and hepatic hydrothorax were assessed using receiver operating characteristic (ROC) curves.</p> Results <p>The CPS was more accurate in predicting ascites (<i>AUC</i> = 0.753), while MELD and MELD-Na scores more reliably predicted hepatic encephalopathy and hepatorenal syndrome (AUCs from 0.734 to 0.834). None of the scoring systems was effective in predicting varices or hepatic hydrothorax, with AUCs approaching 0.5.</p> Conclusion <p>The CPS remains a robust predictor for ascites, and the MELD scores, particularly when sodium is included, are better for predicting hepatorenal syndrome and HCC. The limited utility of these scores for predicting varices and hepatic hydrothorax underscores the necessity for developing more sophisticated models or utilizing additional clinical parameters in prognostication.</p>