medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

, specifically

gastroenterology Gastroenterology (from the Greek gastḗr- “belly”, -énteron “intestine”, and -logía "study of") is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract ...

, 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 Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...

. 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 Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, al ...

Scoring

The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement. Either the prothrombin time or INR should be used to calculate the Child–Pugh score, not both. In

primary sclerosing cholangitis Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts, which normally allow bile to drain from the gallbladder. Affected individuals may ha ...

(PSC) and

primary biliary cholangitis Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is an autoimmune disease of the liver. It results from a slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to build ...

(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 Bilirubin (BR) (Latin for "red bile") is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. This catabolism is a necessary process in the body's clearance of waste products that arise from the ...

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).

Interpretation

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

Related scoring systems

* MELD Score *

MELD-Plus MELD-Plus is a risk score to assess severity of chronic liver disease that was resulted from a collaboration between Massachusetts General Hospital and IBM. The score includes nine variables as effective predictors for 90-day mortality after a dis ...

History

The surgeon and portal hypertension expert Charles Gardner Child (1908–1991) (with Turcotte) of the

University of Michigan , mottoeng = "Arts, Knowledge, Truth" , former_names = Catholepistemiad, or University of Michigania (1817–1821) , budget = $10.3 billion (2021) , endowment = $17 billion (2021)As o ...

first proposed the scoring system in 1964 in a textbook on liver disease. It was modified by Pugh et al. in 1972 in a report on surgical treatment of bleeding from

esophageal varices Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop ...

. They replaced Child's criterion of nutritional status with the

prothrombin time The prothrombin time (PT) – along with its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) – is an assay for evaluating the ''extrinsic'' pathway and common pathway of coagulation. This blood test is als ...

or INR, and assigned scores of 1–3 to each variable.

References

External links

Child–Pugh calculator from LiverpoolMedics

Online calculator of the Child–Pugh score
{{DEFAULTSORT:Child Pugh Score Diagnostic gastroenterology Hepatology Medical scoring system Medical mnemonics