What is child pugh criteria
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Child-Pugh score liver cirrhosis
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Child-Pugh Criteria (Child-Turcotte-Pugh Score)
Background
Originally devised by Child and Turcotte (1964), then modified by Pugh (1973), this scoring system was created to stratify patients with cirrhosis into risk groups before portal decompressive surgery. It remains widely used to assess the severity of chronic liver disease and predict complications.
The Five Parameters
Each parameter is scored 1, 2, or 3 based on the degree of abnormality:
| Factor | Score 1 | Score 2 | Score 3 |
|---|---|---|---|
| Serum Bilirubin | < 2.0 mg/dL (< 34 µmol/L) | 2.0-3.0 mg/dL (34-51 µmol/L) | > 3.0 mg/dL (> 51 µmol/L) |
| Serum Albumin | > 3.5 g/dL (> 35 g/L) | 3.0-3.5 g/dL (30-35 g/L) | < 3.0 g/dL (< 30 g/L) |
| Prothrombin Time / INR | < 4 sec prolonged / INR < 1.7 | 4-6 sec / INR 1.7-2.3 | > 6 sec / INR > 2.3 |
| Ascites | None | Easily controlled | Poorly controlled |
| Hepatic Encephalopathy | None | Minimal (Grade 1-2) | Advanced (Grade 3-4) |
- Harrison's Principles of Internal Medicine 22E, Table 347-6
Classification
| Class | Total Score | Interpretation | 1-Year Survival | 2-Year Survival |
|---|---|---|---|---|
| A | 5-6 | Well-compensated (compensated cirrhosis) | ~100% | ~85% |
| B | 7-9 | Significant functional compromise | ~80% | ~60% |
| C | 10-15 | Decompensated cirrhosis | ~45% | ~35% |
Clinical Uses
- Surgical risk stratification - Class A: surgery generally tolerable; Class B/C: elective surgery usually avoided
- Liver transplant listing - A Child-Pugh score ≥7 (Class B) was the traditional criterion for listing patients for transplantation (now largely replaced by MELD)
- HCC management - Class C patients are not candidates for liver resection; Class A patients can usually tolerate some resection
- Drug dosing - Many drugs (antivirals, psychiatric medications, etc.) require dose adjustment in Class B and are contraindicated or require extreme caution in Class C
- Predicting complications - Predicts likelihood of variceal bleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome
Limitations & Comparison with MELD
The Child-Pugh score has been largely supplanted by the MELD score for transplant allocation and surgical risk because:
- Ascites and encephalopathy are subjectively assessed, introducing variability
- MELD uses only objective lab values (INR, creatinine, bilirubin) and is better validated for predicting 90-day mortality
- However, in patients with severe portal hypertension but preserved hepatic synthetic function, MELD may underperform and Child-Pugh remains more informative
- Sabiston Textbook of Surgery, p. 1042-1043
Note: Child-Pugh is a "static snapshot" of liver function, while MELD better reflects dynamic deterioration. Both systems have complementary roles in clinical practice.
Memory Aid
Think "BAP + AE":
- Bilirubin
- Albumin
- Prothrombin time / INR
- Ascites
- Encephalopathy
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