Child Pugh Score

The method explained

This is a disease severity evaluation based on the Child- Turcotte- Pugh score that determines the prognosis of hepatic disease.

There are two clinical assessments and three test measurements used to score cirrhosis and other liver disease:

■ The hepatic encephalopathy status varies from none to grade III or IV. This encephalopathy occurs when toxins from the blood affect the central nervous system because the liver is not able to eliminate them.

■ Ascites assessment refers to absence or presence of ascites, and if so, the level of severity. Liver dysfunction leads to fluid build up between the peritoneum layers.

■ Bilirubin level is an indicator of liver function, resulted from the metabolism of old red blood cells.

■ Serum albumin is normally between 2.8 and 3.5 g/dL and any disruption indicates impaired liver function.

■ International normalized ratio (INR) offers information on coagulation and reflects whether the liver produces clotting factors appropriately.

Score interpretation

The five items in the score are awarded points, from 1 to 3, depending on their weight on liver disease.

The final score is calculated by summing the points. This result is interpreted as belonging to one of three classes of disease severity, as described in the table below:

Class A is also known as well compensated disease, class B shows significant functional compromise whilst class C indicates that hepatic disease is decompensated.

When to use the Child Pugh score

The original use of the Child- Turcotte- Pugh score was in surgery, as a mortality risk tool. Currently it has evolved to being used for prognostic purposes and to support other assessment methods in predicting the need for liver transplant (EPTS score).

The score is also often used in conjunction with the Model for End Stage Liver Disease, MELD score, especially in patient with abnormally high or low scores.

The score can evaluate disease severity in the following conditions:

■ Ascites;

■ Alcoholic or billiary cirrhosis;

■ Cirrhosis from Hepatitis C virus;

■ Primary sclerosing cholangitis;

■ Ruptured esophageal varices.

Original source

Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.

Validation

Pugh RNH, Murray-Lyon IM, Dawson JL et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:649-9.

Other references

1. Hyung JK, Hyun WL. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol. 2013; 19(2): 105–115.

2. Peng Y, Qi X, Guo X. Child–Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis - A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 2016; 95(8): e2877.