Child pugh score
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"Child-Pugh" score liver cirrhosis
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Here is a complete breakdown of the Child-Pugh (Child-Turcotte-Pugh) score:
Child-Pugh Score (Child-Turcotte-Pugh / CTP Score)
Background
The CTP score was originally developed to evaluate the risk of portocaval shunt procedures for portal hypertension. It has since been widely used to predict surgical risk in other intra-abdominal operations on cirrhotic patients and to assess prognosis in chronic liver disease. It has largely been replaced by MELD for liver transplant organ allocation, but remains clinically useful.
- Schwartz's Principles of Surgery, 11th Ed.
- Sabiston Textbook of Surgery
Scoring Parameters (5 variables, each scored 1-3)
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Serum Bilirubin | < 2 mg/dL | 2-3 mg/dL | > 3 mg/dL |
| Serum Albumin | > 3.5 g/dL | 2.8-3.5 g/dL | < 2.8 g/dL |
| INR (Prothrombin Time) | < 1.7 | 1.7-2.3 | > 2.3 |
| Ascites | Absent | Slight/Controlled | Moderate/Poorly Controlled |
| Hepatic Encephalopathy | None | Grade 1-2 (Minimal) | Grade 3-4 (Advanced) |
Total score range: 5 to 15
Classification
| Class | Score | 1-Year Survival | 2-Year Survival | Surgical Mortality |
|---|---|---|---|---|
| A (Compensated) | 5-6 | ~100% | ~85% | ~10% |
| B | 7-9 | ~80% | ~60% | ~30% |
| C (Decompensated) | 10-15 | ~45% | ~35% | 75-80% |
- Harrison's Principles of Internal Medicine, 22nd Ed., Table 347-6
- Schwartz's Principles of Surgery, 11th Ed.
Clinical Significance
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Liver transplantation: A Child-Pugh score ≥7 (class B) indicates decompensation and was historically the accepted criterion for listing a patient for liver transplantation. This role has now been taken over by the MELD score.
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Surgical risk: Class A patients may undergo elective surgery; Class B is borderline and must be individualized; Class C has prohibitive mortality and elective surgery should be avoided. - Sabiston Textbook of Surgery
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Variceal bleeding: 40% of Child-Pugh grade A patients have esophageal varices, rising to 85% in grade C patients. - Symptom to Diagnosis, 4th Ed.
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HCC resection: Child-Pugh class B patients are generally borderline candidates for hepatic resection; major resections are poorly tolerated.
Limitations
- Two parameters (ascites and encephalopathy) are subjective, introducing inter-observer variability.
- The score has a narrow range (5-15) and gives equal weight to all five variables, which may not reflect their true clinical impact.
- Because of these limitations, CTP scores have largely been supplanted by the MELD score for surgical risk stratification, which uses only objective lab values (INR, bilirubin, creatinine). - Sabiston Textbook of Surgery
CTP vs. MELD - Key Differences
| Feature | Child-Pugh | MELD |
|---|---|---|
| Variables | 5 (includes subjective) | 3 (all objective) |
| Range | 5-15 (narrow) | 6-40 |
| Includes | Ascites, encephalopathy | Creatinine (renal function) |
| Best use | Patients with severe portal HTN but preserved synthetic function | Predicting short-term mortality; organ allocation |
When portal hypertension is severe but hepatic synthetic function is preserved, the MELD score may underestimate risk and the CTP score may be more informative. - Sabiston Textbook of Surgery
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