Template:Short description Template:Infobox diagnostic In medicine, specifically gastroenterology, the Child–Pugh score (or the Child–Turcotte–Pugh (CTP) 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.Template:Cn

ScoringEdit

The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.<ref name=Cholongitas>Template:Cite journal</ref>

Either the prothrombin time or INR should be used to calculate the Child–Pugh score, not both.

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
OR Prothrombin time, prolongation (s) < 4.0
4.0–6.0
> 6.0
INR < 1.7 1.7–2.3 > 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).<ref>Template:Cite journal</ref>

InterpretationEdit

Chronic liver disease is classified into Child–Pugh class A to C, employing the added score from above.<ref name=Cholongitas/>

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

Related scoring systemsEdit

HistoryEdit

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

ReferencesEdit

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External linksEdit

Template:Digestive system procedures