From the Guidelines
Child-Pugh Class B patients have a moderate liver dysfunction with a 1-year survival rate of approximately 80% and a 2-year survival rate of about 60%, and their management should focus on treating the underlying cause of liver disease, preventing further decompensation, and addressing complications, with consideration for liver transplantation as the definitive treatment for decompensated cirrhosis. Patients with Child-Pugh B cirrhosis have a MELD (Model for End-Stage Liver Disease) score typically ranging from 10-15, which corresponds to a 3-month mortality risk of 6-20% 1. These patients often experience complications such as:
- Ascites
- Mild to moderate encephalopathy
- Decreased synthetic liver function Management of Child-Pugh B patients includes:
- Sodium restriction (2000 mg/day)
- Diuretics like spironolactone (starting at 100 mg daily) and furosemide (starting at 40 mg daily) for ascites
- Lactulose (30-45 mL 2-4 times daily) for encephalopathy
- Prophylactic antibiotics like norfloxacin (400 mg daily) for those with prior spontaneous bacterial peritonitis According to the most recent guidelines, patients with Child-Pugh scores of 10–13 and patients with Child-Pugh scores of 8–9 who had active variceal bleeding at initial endoscopy are patients at high risk who would likely benefit from p-TIPS 1. Regular monitoring of liver function, electrolytes, and screening for hepatocellular carcinoma with ultrasound every 6 months is essential. The prognosis can improve with abstinence from alcohol, viral hepatitis treatment, or management of other underlying conditions causing liver damage.
From the Research
Child Pugh B Prognosis
- The prognosis for patients with Child-Pugh B cirrhosis varies depending on the underlying cause of the cirrhosis and the presence of other health conditions 2, 3, 4, 5, 6.
- Studies have shown that patients with Child-Pugh B cirrhosis have a higher risk of decompensation and mortality compared to those with Child-Pugh A cirrhosis 3, 5, 6.
- The Child-Pugh score is a widely used system for assessing the prognosis of patients with cirrhosis, but it has some limitations, such as being subjective and not taking into account other important factors like renal function 5, 6.
- The MELD score is another system used to assess the prognosis of patients with cirrhosis, and it has been shown to be a good predictor of mortality in these patients 5, 6.
- A study comparing the Child-Pugh and MELD scores found that they had similar prognostic values in most cases, but the MELD score was more accurate in predicting mortality in patients with acute-on-chronic liver failure 5.
- Another study found that the MELD score was a better predictor of postoperative mortality in cirrhotic patients undergoing surgery than the Child-Pugh score 6.
- Treatment options for patients with Child-Pugh B cirrhosis are limited, but some studies have shown that certain medications, such as sofosbuvir and velpatasvir, can be effective in treating hepatitis C virus-related cirrhosis in these patients 2, 4.
- Liver resection can be a viable treatment option for patients with hepatocellular carcinoma and Child-Pugh B cirrhosis, but it is associated with a high risk of postoperative complications 3.
Treatment Options
- Sofosbuvir and velpatasvir have been shown to be effective in treating hepatitis C virus-related cirrhosis in patients with Child-Pugh B cirrhosis 2, 4.
- Liver resection can be a viable treatment option for patients with hepatocellular carcinoma and Child-Pugh B cirrhosis, but it is associated with a high risk of postoperative complications 3.
- The use of protease inhibitors, such as glecaprevir and pibrentasvir, can be considered in patients with Child-Pugh B cirrhosis who have failed other treatments 2.
Predicting Outcomes
- The Child-Pugh and MELD scores can be used to predict outcomes in patients with cirrhosis, but they have some limitations 5, 6.
- A study found that the MELD score was a better predictor of postoperative mortality in cirrhotic patients undergoing surgery than the Child-Pugh score 6.
- Another study found that the Child-Pugh score had a higher sensitivity and a lower specificity than the MELD score in predicting mortality in patients with acute-on-chronic liver failure 5.