Child–Pugh score

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Child–Pugh score
Purposedetermine best treatment for liver disease

In medicine, specifically gastroenterology, the Child–Pugh score (or the Child–Turcotte–Pugh (CTP) score or Child Criteria) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation.[citation needed]

Scoring

The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.[1]

Either the prothrombin time or INR should be used to calculate the Child–Pugh score, not both.

Measure 1 point 2 points 3 points
Total bilirubin, μmol/L (mg/dL) < 34 (< 2) 34–50 (2–3) > 50 (> 3)
Serum albumin, g/dL > 3.5 2.8–3.5 < 2.8
OR Prothrombin time, prolongation (s) < 4.0
 4.0–6.0
 > 6.0
INR
 < 1.7 1.7–2.3 > 2.3
Ascites None Mild (or suppressed with medication) Moderate to severe (or refractory)
Hepatic encephalopathy None Grade I–II Grade III–IV

In

conjugated bilirubin levels. The upper limit for 1 point is 68 μmol/L (4 mg/dL) and the upper limit for 2 points is 170 μmol/L (10 mg/dL).[2]

Interpretation

Chronic liver disease is classified into Child–Pugh class A to C, employing the added score from above.[1]

Points Class One-year survival Two-year survival
5–6 A 100% 85%
7–9 B 80% 60%
10–15 C 45% 35%

Related scoring systems

History

The surgeon and portal hypertension expert Charles Gardner Child (1908–1991) (with Turcotte) of the University of Michigan first proposed the scoring system in 1964 in a textbook on liver disease.[3] It was modified by Pugh et al. in 1972 in a report on surgical treatment of bleeding from esophageal varices.[4] They replaced Child's criterion of nutritional status with the prothrombin time or INR, and assigned scores of 1–3 to each variable.[1]

References

  1. ^
    PMID 16305721
    .
  2. S2CID 42862030
    .
  3. ^ Child CG, Turcotte JG (1964). "Surgery and portal hypertension". In Child CG (ed.). The liver and portal hypertension. Philadelphia: Saunders. pp. 50–64.
  4. S2CID 382636.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )

External links
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