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Child-Pugh score
The Child-Pugh classification (sometimes the Child-Turcotte-Pugh score) 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.
Score
The score employs five clinical measures of liver disease. Each
measure is scored 1-3, with 3 indicating most severe derangement.
| Measure |
1 point |
2 points |
3 points |
units |
|
Bilirubin (total) |
<34 (<2) |
34-50 (2-3) |
>50 (>3) |
μmol/l (mg/dL) |
| Serum
albumin |
>35 |
28-35 |
<28 |
mg/L |
|
INR |
<1.7 |
1.71-2.20 |
> 2.20 |
no unit |
|
Ascites |
None |
Suppressed with medication |
Refractory |
no unit |
|
Hepatic encephalopathy |
None |
Grade I-II (or suppressed with medication) |
Grade III-IV (or refractory) |
no unit |
It should be noted that different textbooks and publications use
different measures. Some older reference works substitute PT
prolongation for
INR.
In primary sclerosing cholangitis (PSC) and
primary biliary cirrhosis (PBC),
the
bilirubin references are changed to reflect the fact that these
diseases feature high 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).
Interpretation
Chronic liver disease is classified into Child-Pugh class A to C,
employing the added score from above.
| Points |
Class |
Life expectancy |
Perioperative mortality |
| 5-6 |
A |
15-20 |
10% |
| 7-9 |
B |
Candidate for transplant |
30% |
| 10-15 |
C |
1-3 months |
82% |
Other scoring systems
Although the Child-Turcotte scoring system was the first of its kind
in stratifying the seriousness of end-stage liver disease, it is by no
means the only one. The Model for End-Stage Liver Disease (MELD) is used
increasingly to assess patients for liver transplantation, although both
scores seem to be more or less equivalent.
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History
Dr C.G. Child and Dr J.G. Turcotte of the University of Michigan
first proposed the scoring system in 1964 (Child CG, Turcotte JG.
Surgery and portal hypertension. In: The liver and portal hypertension.
Edited by CG Child. Philadelphia: Saunders 1964:50-64). It was modified
by Pugh in 1972 (see reference below). He replaced Child's criterion of
nutritional status with the prothrombin time or
INR, and
thus eliminated the most subjective part of the score.
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