What are the indications to calculate Chil-Pugh score?
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Indications for Calculating the Child-Pugh Score
The Child-Pugh (Child-Turcotte-Pugh, CTP) score was developed to assess the severity of liver dysfunction and portal hypertension in patients with cirrhosis. It scores five parameters — serum bilirubin, serum albumin, prothrombin time/INR, ascites, and hepatic encephalopathy — giving a total of 5–15 points, stratified into classes A, B, and C.
Clinical Indications
| Indication | Detail |
|---|---|
| Pre-operative surgical risk stratification | Class A patients may tolerate elective surgery; class B/C patients are generally not candidates for elective surgery. Ascites in this context correlates reliably with poor surgical outcomes. |
| Assessing prognosis in cirrhosis | The score reliably predicts survival and the likelihood of major complications such as variceal bleeding and spontaneous bacterial peritonitis (SBP). |
| Liver transplantation listing (historical) | Class B (score ≥7) was the accepted criterion for listing a patient as a candidate for liver transplantation. This role has largely been replaced by the MELD score. |
| Portal decompressive surgery | The score was originally devised to stratify patients with cirrhosis into risk groups before portal decompressive (portosystemic shunt) surgery. |
| Hepatocellular carcinoma (HCC) management | Used to determine eligibility for resectional therapy: class C patients are not candidates; class A patients can usually tolerate hepatic resection. |
| Drug dosing adjustments | Many drugs require dose modification based on Child-Pugh class (A = mild, B = moderate, C = severe hepatic impairment), as hepatic metabolism is impaired progressively across classes. |
| Management of variceal bleeding | Child-Pugh class guides the choice of rebleeding-prevention strategies (e.g., beta-blocker ± variceal ligation efficacy varies by class). |
| TIPS placement risk assessment | Used alongside MELD to stratify risk in patients with severe portal hypertension but preserved synthetic function, where MELD may underestimate risk. |
Child-Pugh Classification Summary
| Score | Class | Interpretation |
|---|---|---|
| 5–6 | A | Compensated cirrhosis — well-preserved function |
| 7–9 | B | Moderate dysfunction — "decompensation" threshold |
| ≥10 | C | Severe dysfunction |
Current Context
While the Child-Pugh score remains widely used, the MELD score has superseded it for transplant listing and surgical risk stratification in many centers, owing to its fully objective variables (INR, bilirubin, creatinine). Child-Pugh retains clinical utility when portal hypertension is severe but synthetic function is relatively preserved, or as a quick bedside tool for communicating overall liver reserve.
— Harrison's Principles of Internal Medicine 22E, p. 2676; Sabiston Textbook of Surgery, p. 1042
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