Child-Pugh score

Child-Pugh Score

The Child-Pugh scoreis a clinical tool used to assess the prognosis of chronic liver disease, primarily cirrhosis. It helps in determining the severity of liver disease and the necessary treatment approach. The score is named after Dr. Charles Gardner Child and Dr. Tomás Pugh, who developed the scoring system.

Components

The Child-Pugh score is calculated based on five clinical measures of liver disease. Each measure is scored from 1 to 3, with 3 indicating the most severe derangement. The total score ranges from 5 to 15.

1. Bilirubin

Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. Elevated levels indicate liver dysfunction.

• 1 point: < 2 mg/dL
• 2 points: 2-3 mg/dL
• 3 points: > 3 mg/dL

2. Serum Albumin

Albumin is a protein made by the liver. Low levels can indicate poor liver function.

• 1 point: > 3.5 g/dL
• 2 points: 2.8-3.5 g/dL
• 3 points: < 2.8 g/dL

3. Prothrombin Time (PT) or International Normalized Ratio (INR)

Prothrombin time measures how long it takes blood to clot. The INR is a standardized way of expressing PT.

• 1 point: PT prolongation < 4 seconds or INR < 1.7
• 2 points: PT prolongation 4-6 seconds or INR 1.7-2.3
• 3 points: PT prolongation > 6 seconds or INR > 2.3

4. Ascites

Ascites is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

• 1 point: None
• 2 points: Mild
• 3 points: Moderate to severe

5. Hepatic Encephalopathy

Hepatic encephalopathy is a decline in brain function as a result of severe liver disease.

• 1 point: None
• 2 points: Grade I-II (or suppressed with medication)
• 3 points: Grade III-IV (or refractory)

Classification

The total Child-Pugh score is used to classify the severity of liver disease into three classes:

• Class A: 5-6 points (well-compensated disease)
• Class B: 7-9 points (significant functional compromise)
• Class C: 10-15 points (decompensated disease)

Clinical Use

The Child-Pugh score is used to assess the prognosis of liver disease and to guide treatment decisions. It is particularly useful in:

• Determining the need for liver transplantation.
• Assessing the risk of surgery in patients with liver disease.
• Guiding the management of cirrhosis and its complications.

Limitations

While the Child-Pugh score is widely used, it has limitations. It does not account for all factors affecting liver disease prognosis, such as renal function or the presence of hepatocellular carcinoma. Newer models, like the MELD score, have been developed to address some of these limitations.

Also see

• Cirrhosis
• Liver transplantation
• Hepatic encephalopathy
• Ascites
• Model for End-Stage Liver Disease