Child–Pugh score

In medicine, specifically gastroenterology, the Child–Pugh score (or the Child–Turcotte–Pugh score or Child Criteria) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation.

Scoring

The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.[1]

Measure 1 point 2 points 3 points
Total bilirubin, μmol/L (mg/dL) <34 (<2) 34–50 (2–3) >50 (>3)
Serum albumin, g/dL >3.5 2.8–3.5 <2.8
Prothrombin time, prolongation (s) OR

INR

 <4.0

<1.7

 4.0–6.0

1.7-2.3

 > 6.0

>2.3

Ascites None Mild (or suppressed with medication) Moderate to severe (or refractory)
Hepatic encephalopathy None Grade I–II Grade III–IV

In primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC), some use a modified Child Pugh score where the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels. The upper limit for 1 point is 68 μmol/L (4 mg/dL) and the upper limit for 2 points is 170 μmol/L (10 mg/dL).[2]

Mnemonic: "Pour Another Beer At Eleven" for PT, Ascites, Bilirubin, Albumin, Encephalopathy

Interpretation

Chronic liver disease is classified into Child–Pugh class A to C, employing the added score from above.[1]

Points Class One year survival Two year survival
5–6 A 100% 85%
7–9 B 80% 60%
10–15 C 45% 35%

History

The surgeon and portal hypertension expert, Dr. Charles Gardner Child (1908–1991) (with Dr. Turcotte) of the University of Michigan first proposed the scoring system in 1964 in a textbook on liver disease.[3] It was modified by Pugh et al in 1972 in a report on surgical treatment of bleeding from esophageal varices.[4] They replaced Child's criterion of nutritional status with the prothrombin time or INR, and assigned scores of 1–3 to each variable.[1]

References

  1. 1 2 3 Cholongitas, E; Papatheodoridis, GV; Vangeli, M; Terreni, N; Patch, D; Burroughs, AK (Dec 2005). "Systematic review: The model for end-stage liver disease--should it replace Child-Pugh's classification for assessing prognosis in cirrhosis?". Alimentary Pharmacology & Therapeutics. 22 (11–12): 1079–89. doi:10.1111/j.1365-2036.2005.02691.x. PMID 16305721.
  2. ↑ Working Subgroup (English version) for Clinical Practice Guidelines for Primary Biliary Cirrhosis (2014-01-01). "Guidelines for the management of primary biliary cirrhosis". Hepatology Research. 44: 71–90. doi:10.1111/hepr.12270. ISSN 1872-034X.
  3. ↑ Child CG, Turcotte JG (1964). "Surgery and portal hypertension". In Child CG. The liver and portal hypertension. Philadelphia: Saunders. pp. 50–64.
  4. ↑ Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). "Transection of the oesophagus for bleeding oesophageal varices". The British Journal of Surgery. 60 (8): 646–9. doi:10.1002/bjs.1800600817. PMID 4541913.
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