Child-Pugh Score Calculator
Assess the severity of cirrhosis and predict prognosis using the Child-Pugh classification system. Calculate surgical risk and survival rates for liver disease patients.
Calculate Child-Pugh Score
Survival and Surgical Risk by Class
| Outcome | Class A (5-6) | Class B (7-9) | Class C (10-15) |
|---|---|---|---|
| 1-Year Survival | 100% | 80% | 45% |
| 2-Year Survival | 85% | 60% | 35% |
| Perioperative Mortality | 10% | 30% | > 80% |
| Surgical Candidacy | Good | Moderate | Poor |
Child-Pugh Scoring Criteria
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Bilirubin (mg/dL) | < 2 | 2-3 | > 3 |
| Albumin (g/dL) | > 3.5 | 2.8-3.5 | < 2.8 |
| INR | < 1.7 | 1.7-2.3 | > 2.3 |
| Ascites | None | Mild/Controlled | Moderate/Refractory |
| Encephalopathy | None | Grade I-II | Grade III-IV |
Understanding Child-Pugh Score
What is the Child-Pugh Score?
The Child-Pugh score (also known as Child-Turcotte-Pugh or CTP score) is a clinical scoring system used to assess the prognosis and severity of chronic liver disease, particularly cirrhosis. It combines five clinical and laboratory parameters to classify patients into three categories (A, B, and C) based on disease severity.
Clinical Applications
- Surgical Risk Assessment: Determines perioperative risk for patients with cirrhosis undergoing surgery
- Prognosis Estimation: Predicts 1-year and 2-year survival rates
- Treatment Planning: Guides decisions about liver transplantation, TIPS procedures, and other interventions
- Clinical Trials: Used to stratify patients in research studies
- Variceal Bleeding Risk: Helps assess risk of complications from portal hypertension
History and Development
The scoring system was originally developed by Child and Turcotte in 1964 to assess surgical risk in patients with cirrhosis undergoing portacaval shunt surgery. It was later modified by Pugh in 1973, replacing nutritional status with prothrombin time/INR, creating the modern Child-Pugh classification.
Limitations
- Subjective components (ascites and encephalopathy grading) can lead to inter-observer variability
- Does not include renal function, which is an important prognostic factor
- Ceiling effect - cannot distinguish among the sickest patients (all Class C)
- Has been largely replaced by MELD score for liver transplant allocation
- May underestimate disease severity in cholestatic liver diseases
Child-Pugh vs MELD
While both scores assess liver disease severity, they have different strengths:
- Child-Pugh: Better for surgical risk assessment and general prognosis. Includes clinical parameters (ascites, encephalopathy)
- MELD: Better for transplant allocation. Uses only objective laboratory values. Includes renal function (creatinine)
- MELD is now the standard for transplant prioritization in most countries
- Child-Pugh remains valuable for perioperative risk stratification and clinical decision-making
Modified Criteria for PBC
In Primary Biliary Cholangitis (PBC), modified bilirubin cutoffs are used because cholestatic diseases typically have higher bilirubin levels:
- 1 point: Bilirubin < 4 mg/dL
- 2 points: Bilirubin 4-10 mg/dL
- 3 points: Bilirubin > 10 mg/dL
Frequently Asked Questions
What does each Child-Pugh class mean?
Class A (5-6 points) indicates compensated cirrhosis with good prognosis. Class B (7-9 points) shows significant liver dysfunction with moderate prognosis. Class C (10-15 points) represents decompensated cirrhosis with poor prognosis and high surgical risk.
Can Child-Pugh score improve over time?
Yes, with treatment of the underlying liver disease (e.g., alcohol cessation, antiviral therapy for hepatitis) and management of complications, parameters like bilirubin, albumin, and ascites can improve, leading to a better Child-Pugh score.
How is hepatic encephalopathy graded?
Hepatic encephalopathy is graded 0-IV: Grade 0 (none), Grade I (mild confusion, altered mood), Grade II (drowsiness, inappropriate behavior), Grade III (stupor, severe confusion), Grade IV (coma). For Child-Pugh, Grades I-II score 2 points, and Grades III-IV score 3 points.
What is considered refractory ascites?
Refractory ascites is defined as ascites that cannot be mobilized or recurs rapidly despite maximum diuretic therapy (spironolactone 400 mg/day and furosemide 160 mg/day) and sodium restriction. This typically requires therapeutic paracentesis and scores 3 points.
When should elective surgery be avoided?
Elective surgery should generally be avoided in Child-Pugh Class C patients due to >80% perioperative mortality. Class B patients require careful evaluation and optimization before surgery. Only Class A patients are considered good surgical candidates.
Is Child-Pugh still used for liver transplant allocation?
In most countries including the United States, MELD/MELD-Na has replaced Child-Pugh for transplant allocation because it uses objective criteria and better predicts mortality. However, Child-Pugh remains useful for clinical assessment and surgical risk stratification.
What causes the low albumin in cirrhosis?
Low albumin in cirrhosis results from decreased hepatic synthesis (liver produces less albumin), increased distribution volume (ascites and edema), and increased catabolism. Albumin <2.8 g/dL indicates significant hepatic synthetic dysfunction.
How does Child-Pugh relate to TIPS procedures?
TIPS (transjugular intrahepatic portosystemic shunt) is generally safe in Class A, carries moderate risk in Class B, and has high mortality in Class C. MELD score is now preferred for TIPS risk stratification, with MELD >18 associated with poor outcomes.
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