Child–Pugh score explained

Child–Pugh score
Purpose:determine 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.

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.

Measure1 point2 points3 points
Total bilirubin, μmol/L (mg/dL)< 34 (< 2)34–50 (2–3)> 50 (> 3)
Serum albumin, g/dL> 3.52.8–3.5< 2.8
ORProthrombin time, prolongation (s) < 4.0
4.0–6.0
> 6.0
INR< 1.71.7–2.3> 2.3
AscitesNoneMild (or suppressed with medication)Moderate to severe (or refractory)
Hepatic encephalopathyNoneGrade I–II Grade III–IV
In primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC), some use a modified Child–Pugh score where 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).[2]

Interpretation

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

PointsClassOne-year survivalTwo-year survival
5–6A100%85%
7–9B80%60%
10–15C45%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]

External links

Notes and References

  1. Cholongitas. E. Papatheodoridis, GV . Vangeli, M . Terreni, N . Patch, D . Burroughs, AK . Systematic review: The model for end-stage liver disease--should it replace Child–Pugh's classification for assessing prognosis in cirrhosis?. Alimentary Pharmacology & Therapeutics. Dec 2005. 22. 11–12. 1079–89. 10.1111/j.1365-2036.2005.02691.x. 16305721. free.
  2. Working Subgroup (English version) for Clinical Practice Guidelines for Primary Biliary Cirrhosis. 2014-01-01. Guidelines for the management of primary biliary cirrhosis. Hepatology Research. en. 44. 71–90. 10.1111/hepr.12270. 24397841. 42862030 . 1872-034X. free.
  3. Book: Child CG, Turcotte JG . Surgery and portal hypertension . The liver and portal hypertension . Child CG . Philadelphia . Saunders . 1964 . 50–64.
  4. . Transection of the oesophagus for bleeding oesophageal varices . The British Journal of Surgery . 60 . 8 . 646–9 . 1973 . 4541913. 10.1002/bjs.1800600817. 382636 .