What is the Child-Pugh (Child-Pugh score) score?

From the Guidelines

The Child-Pugh score is a crucial clinical assessment tool used to evaluate liver function and predict prognosis in patients with chronic liver disease, consisting of five parameters: total bilirubin, serum albumin, prothrombin time/INR, presence and severity of ascites, and hepatic encephalopathy, with higher scores indicating worse function 1. The Child-Pugh score classifies patients into three groups: Class A (5-6 points) indicates well-compensated disease with good prognosis, Class B (7-9 points) indicates significant functional compromise with intermediate prognosis, and Class C (10-15 points) indicates decompensated disease with poor prognosis. Key points to consider when using the Child-Pugh score include:

• The development of ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepatorenal syndrome also have a significant impact on the prognosis of patients with cirrhosis 1.
• The 5-year survival rate of individuals in whom any of these complications develop is only 20% to 50% of patients with compensated cirrhosis 1.
• The Child-Pugh score helps guide treatment decisions, including medication dosing, surgical risk assessment, and transplant prioritization, and is particularly valuable for determining the severity of cirrhosis and estimating survival rates 1.
• The score's simplicity makes it widely applicable in clinical settings, though it has limitations as it doesn't account for renal function or certain complications of portal hypertension 1. In clinical practice, the Child-Pugh score should be used to guide treatment decisions, with Class A patients considered for specific treatment options, Class B patients evaluated for liver transplantation or other treatments, and Class C patients offered supportive care 1.

From the Research

Child Pugh Score Overview

• The Child Pugh score is a system used to assess the prognosis of patients with cirrhosis, taking into account factors such as albumin and bilirubin levels, prothrombin time, and the presence of ascites and encephalopathy 2.
• The score has been widely used for many years, but it has some limitations, including subjective interpretation of some variables, which can make it difficult to categorize patients according to their disease severity 3.

Comparison with MELD Score

• The Model for End-Stage Liver Disease (MELD) score is another system used to assess the prognosis of patients with cirrhosis, and it has been compared to the Child Pugh score in several studies 4, 5, 6.
• Some studies have found that the MELD score is slightly superior to the Child Pugh score in predicting mortality, while others have found no significant difference between the two scores 4, 5.
• A systematic review and meta-analysis found that the Child Pugh and MELD scores had similar prognostic values in most cases, but their benefits might be heterogeneous in some specific conditions 5.

Clinical Applications

• The Child Pugh score is an independent prognostic factor for recipient survival, and stage C in the Child Pugh classification is strongly related to worse survival 2.
• The MELD score is especially useful for prioritizing candidates for transplantation according to a "sickest first" policy, but it is not a universal prognostic marker of cirrhosis and several MELD exceptions require more specific approaches 3.
• The indications for Child Pugh and MELD scores should be further identified, and modified Child Pugh and MELD scores need further evaluation 5, 6.

Key Findings

• The Child Pugh score has important limitations, including subjective interpretation of some variables, which can make it difficult to categorize patients according to their disease severity 3.
• The MELD score does not reflect the severity of patients with hepatocellular carcinoma or metabolic disorders 4.
• Hepatic encephalopathy and hyponatraemia, both components of the Child Pugh score, add to the prognostic performance of the MELD score 6.