Editing Child–Pugh score

{{Short description|Scoring system to assess the prognosis of chronic liver disease}}
{{Infobox diagnostic
| name            = Child–Pugh score
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| purpose         =determine best treatment for liver disease
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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]].{{cn|date=January 2022}}

==Scoring==
The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.<ref name=Cholongitas>{{cite journal|last=Cholongitas|first=E|author2=Papatheodoridis, GV |author3=Vangeli, M |author4=Terreni, N |author5=Patch, D |author6= Burroughs, AK |title=Systematic review: The model for end-stage liver disease--should it replace Child–Pugh's classification for assessing prognosis in cirrhosis?|journal=Alimentary Pharmacology & Therapeutics|date=Dec 2005|volume=22|issue=11–12|pages=1079–89|doi=10.1111/j.1365-2036.2005.02691.x|pmid=16305721|doi-access=free}}</ref>

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

{| class="wikitable" style="border-collapse:collapse"
|-
! colspan=2 | Measure
! 1 point
! 2 points
! 3 points
|-
| colspan=2 | [[Bilirubin|Total bilirubin]], μmol/L (mg/dL)
| < 34 (< 2)
| 34–50 (2–3)
| > 50 (> 3)
|-
| colspan=2 | [[Serum albumin]], g/dL
| > 3.5
| 2.8–3.5
| < 2.8
|-
| rowspan=2 | OR
| [[Prothrombin time]], prolongation (s) 
| < 4.0<br>
| 4.0–6.0<br>
| > 6.0<br> 
|-
| [[International normalized ratio |INR]]
| < 1.7
| 1.7–2.3
| > 2.3
|-
| colspan=2 | [[Ascites]]
| None
| Mild (or suppressed with medication)
| Moderate to severe (or refractory)
|-
| colspan=2 | [[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&nbsp;mg/dL) and the upper limit for 2 points is 170 μmol/L (10&nbsp;mg/dL).<ref>{{Cite journal|last=Working Subgroup (English version) for Clinical Practice Guidelines for Primary Biliary Cirrhosis|date=2014-01-01|title=Guidelines for the management of primary biliary cirrhosis|journal=Hepatology Research|language=en|volume=44|pages=71–90|doi=10.1111/hepr.12270|pmid=24397841|s2cid=42862030 |issn=1872-034X|doi-access=free}}</ref>

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

{| class="wikitable" style="border-collapse:collapse"
! 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 systems==
*[[Model for End-Stage Liver Disease|MELD Score]]
* [[MELD-Plus]]

==History==
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>{{cite book |vauthors=Child CG, Turcotte JG | chapter=Surgery and portal hypertension | title=The liver and portal hypertension | editor=Child CG | location=Philadelphia | publisher=Saunders | year=1964 | pages=50–64}}</ref> It was modified by Pugh et al. in 1972 in a report on surgical treatment of bleeding from [[esophageal varices]].<ref>{{cite journal |author=Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, [[Roger Williams (hepatologist)|Williams R]] |title=Transection of the oesophagus for bleeding oesophageal varices |journal=The British Journal of Surgery |volume=60 |issue=8 |pages=646–9 |year=1973 |pmid=4541913|doi=10.1002/bjs.1800600817|s2cid=382636 }}</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/>

==References==
{{Reflist}}

==External links==
* [http://www.liverpoolmedics.co.uk/clinicalcalculator/childpugh.php Child–Pugh calculator from LiverpoolMedics]
* [https://www.evidencio.com/models/show/253 Online calculator of the Child–Pugh score]

{{Digestive system procedures}}

{{DEFAULTSORT:Child Pugh Score}}
[[Category:Diagnostic gastroenterology]]
[[Category:Hepatology]]
[[Category:Medical scoring system]]
[[Category:Medical mnemonics]]