Child-Pugh score
In medicine (gastroenterology), the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) 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.
| Measure | 1 point | 2 points | 3 points | units |
| Bilirubin (total) | <34.2 (<2) | 34-50 (2-3) | >50 (>3) | μmol/l (mg/dL) |
| Serum albumin | >35 | 28-35 | <28 | g/L |
| INR | <1.7 | 1.71-2.20 | > 2.20 | no unit |
| Ascites | None | Suppressed with medication | Refractory | no unit |
| Hepatic encephalopathy | None | Grade I-II (or suppressed with medication) | Grade III-IV (or refractory) | no unit |
It should be noted that different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
In primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), 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).
Interpretation
Chronic liver disease is classified into Child-Pugh class A to C, employing the added score from above.
| Points | Class | One year survival | Two year survival |
| 5-6 | A | 100% | 85% |
| 7-9 | B | 81% | 57% |
| 10-15 | C | 45% | 35% |
Other scoring systems
Although the Child-Turcotte scoring system was the first of its kind in stratifying the seriousness of end-stage liver disease, it is by no means the only one. The Model for End-Stage Liver Disease (MELD) is used increasingly to assess patients for liver transplantation, although both scores seem to be more or less equivalent[1].
History
Dr C.G. Child and Dr J.G. Turcotte of the University of Michigan first proposed the scoring system in 1964 (Child et al). It was modified by Pugh in 1972 (see reference below). He replaced Child's criterion of nutritional status with the prothrombin time or INR, and thus eliminated the most subjective part of the score.
References
- Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
- Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the esophagus in bleeding oesophageal varices. Br J Surg 1973;60:648-52. PMID 4541913.