Child–Pugh score
| 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.[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 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]
| 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
- ^ a b c Cholongitas, E; Papatheodoridis, GV; Vangeli, M; Terreni, N; Patch, D; Burroughs, AK (Dec 2005). "Systematic review: The model for end-stage liver disease--should it replace Child–Pugh's classification for assessing prognosis in cirrhosis?". Alimentary Pharmacology & Therapeutics. 22 (11–12): 1079–89. doi:10.1111/j.1365-2036.2005.02691.x. PMID 16305721.
- ^ 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. 44: 71–90. doi:10.1111/hepr.12270. ISSN 1872-034X. PMID 24397841. S2CID 42862030.
- ^ Child CG, Turcotte JG (1964). "Surgery and portal hypertension". In Child CG (ed.). The liver and portal hypertension. Philadelphia: Saunders. pp. 50–64.
- ^ Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). "Transection of the oesophagus for bleeding oesophageal varices". The British Journal of Surgery. 60 (8): 646–9. doi:10.1002/bjs.1800600817. PMID 4541913. S2CID 382636.
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