The Child-Pugh scoring system, also known as the Child- Turcotte- Pugh- score, is a clinical tool used to assess the prognosis of chronic liver disease, particularly cirrhosis. It helps determine the severity of liver dysfunction and guide treatment decisions.
Components and Scoring
The score is based on five clinical variables: bilirubin, albumin, prothrombin time (or INR), ascites, and hepatic encephalopathy.
Bilirubin: Measures liver’s ability to clear bilirubin from the blood.
< 2 mg/dL: 1 point
2-3 mg/dL: 2 points
> 3 mg/dL: 3 points
Albumin: Reflects the liver’s synthetic function.
> 3.5 g/dL: 1 point
2.8-3.5 g/dL: 2 points
< 2.8 g/dL: 3 points
Prothrombin Time (or INR): Indicates liver’s ability to produce clotting factors.
< 4 seconds prolongation or INR < 1.7: 1 point
4-6 seconds prolongation or INR 1.7-2.3: 2 points
> 6 seconds prolongation or INR > 2.3: 3 points
Ascites: Presence and severity of fluid accumulation in the abdomen.
None: 1 point
Mild/Moderate (diuretic-responsive): 2 points
Severe (diuretic-refractory): 3 points
Hepatic Encephalopathy: Degree of brain dysfunction due to liver failure.
None: 1 point
Mild (Grade 1-2) : 2 points
Marked (Grade 3-4) : 3 points
Scoring and Classification
Total Score: The sum of points from each category ranges from 5 to 15.
Classification:
Class A: 5-6 points (well-compensated disease)
Class B: 7-9 points (significant functional compromise)
Class C: 10-15 points (decompensated disease)
The Child-Pugh score is a predictor of postoperative mortality after portocaval shunt surgery and predicts mortality risk associated with other major operations.
Child class A patients have a 10% mortality rate; Child class B patients have a 30% mortality rate, and Child class C patients have a 70 to 80% mortality rate.
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