Child Pugh score

Child-Pugh Score
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The Child-Pugh Score is a clinical scoring system used to assess the prognosis of chronic liver disease, primarily cirrhosis. It helps in determining the severity of liver disease and the likelihood of survival, as well as guiding treatment decisions such as the need for liver transplantation.

History

The Child-Pugh Score was originally developed in 1964 by Dr. Charles Gardner Child and Dr. Jeremiah G. Turcotte to predict mortality in patients undergoing portal hypertension surgery. It was later modified by Pugh et al. in 1973 to include the current parameters used today.

Parameters

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.

Clinical Measures

1. Bilirubin: A measure of liver function, elevated levels indicate liver dysfunction.

  - <2 mg/dL = 1 point
  - 2-3 mg/dL = 2 points
  - >3 mg/dL = 3 points

2. Albumin: A protein made by the liver, low levels suggest poor liver function.

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

3. Prothrombin time (or INR): Reflects the liver's ability to produce clotting factors.

  - <4 seconds over control (or INR <1.7) = 1 point
  - 4-6 seconds over control (or INR 1.7-2.3) = 2 points
  - >6 seconds over control (or INR >2.3) = 3 points

4. Ascites: The accumulation of fluid in the peritoneal cavity, indicating portal hypertension.

  - None = 1 point
  - Mild = 2 points
  - Moderate to severe = 3 points

5. Hepatic encephalopathy: A decline in brain function due to severe liver disease.

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

Scoring and Interpretation

The total Child-Pugh Score is the sum of the points from each of the five parameters. The score is then 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 widely used in clinical practice to:

- Assess the prognosis of patients with cirrhosis. - Guide treatment decisions, including the timing of liver transplantation. - Determine the appropriateness of certain therapies, such as transjugular intrahepatic portosystemic shunt (TIPS).

Limitations

While the Child-Pugh Score is a useful tool, it has limitations. It does not account for all factors affecting liver disease prognosis, such as hepatorenal syndrome or hepatocellular carcinoma. Additionally, some parameters, like ascites and encephalopathy, are subjective and may vary between observers.

Also see

• MELD score
• Cirrhosis
• Liver transplantation
• Portal hypertension