Child-Pugh score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]]

Overview

In medicine (gastroenterology), the Child-Pugh score (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.

Historical Perspective

Dr C.G. Child and Dr J.G. Turcotte of the University of Michigan first proposed the scoring system in 1964 (Child et al). 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.

Scoring

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 (<2) 34.2-51.3 (2-3) >51.3 (>3) μmol/l (mg/dL)
Serum albumin >35 28-35 <28 g/L
INR <1.7 1.71-2.3 > 2.3 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. If the PT is <4 seconds than control, it is assigned 1 point. If 4-6 seconds over control, then it scores 2 points and >6 seconds over control, scores 3 points.

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

Not only this, one can also use Child-Pugh to predict development of complications of cirrhosis. A Child-Pugh class C indicates higher chance of developing a bleeding varix than those with class A.[1]

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.

References

  1. de Franchis R, Primignani M (1992). "Why do varices bleed?". Gastroenterology Clinics of North America. 21 (1): 85–101. PMID 1568779. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

2. Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.

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