Child-Pugh Score: Cirrhosis Severity Calculator
Calculate the Child-Pugh score to assess the severity of liver cirrhosis, estimate prognosis, and survival rate. Essential hepatology tool.
Clinical Interpretation & Hepatic Prognosis
The Child-Pugh score classifies the severity of cirrhosis into 3 stages (A, B, and C) and estimates short-to-medium-term survival.
What is the Child-Pugh Score?
Historically developed in 1964 by Child and Turcotte, and modified by Pugh in 1973, the Child-Pugh score is the oldest and most widely used classification in hepatology and gastroenterology. It reproducibly evaluates the degree of hepatocellular insufficiency in patients with chronic liver disease.
Components and Clinical Utility
The score is based on five parameters: ascites, hepatic encephalopathy, total bilirubin, serum albumin, and INR. Each parameter is scored from 1 to 3, yielding a total score of 5 to 15.
Although the MELD (Model for End-Stage Liver Disease) score is now the preferred gold standard for liver transplant allocation, the Child-Pugh score remains essential for daily clinical practice:
- Surgical risk assessment: Crucial before abdominal surgery (e.g., hernia repair).
- Pharmacokinetics: Indispensable for adjusting dosages of drugs metabolized in the liver.
- Monitoring: Dictates the screening frequency for hepatocellular carcinoma (HCC) and esophageal varices.
Medical Limitations & Precautions
The score has some inherent limitations:
- Subjectivity: Assessing ascites and encephalopathy depends on the examiner and diuretic/lactulose use.
- Ceiling Effect: Extreme bilirubin severity does not increase the score beyond the maximum threshold.
- Adjustments (PBC/PSC): In Primary Biliary Cholangitis (PBC) or Primary Sclerosing Cholangitis (PSC), bilirubin thresholds are modified: 1 pt (< 4 mg/dL), 2 pts (4 - 10 mg/dL), 3 pts (> 10 mg/dL).
Classification and Estimated Survival
| Points | Child-Pugh Class | 1-Year / 2-Year Survival |
|---|---|---|
| 5 - 6 | Class A (Compensated Cirrhosis) | 100 % / 85 % |
| 7 - 9 | Class B (Significant Disease) | 80 % / 60 % |
| 10 - 15 | Class C (Decompensated Cirrhosis) | 45 % / 35 % |
References:
1. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964.
[NIH Archive]
2. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973.
[British Journal of Surgery]
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