From the Guidelines
The Child-Pugh score is a system used to assess the severity of liver disease, primarily cirrhosis, and predict mortality risk.
Components of the Child-Pugh Score
The score is calculated based on five parameters:
- Encephalopathy (grade): None, 1-2, or 3-4
- Ascites: Absent, slight, or moderate
- Bilirubin (mg/dL): 1-2-3, or >3
- Albumin (g/dL): >3.5,2.8-3.5, or <2.8
- Prothrombin time (seconds prolonged) or INR: 1-4-6, or >6
Calculation of the Child-Pugh Score
Each parameter is assigned a score of 1,2, or 3, with 3 indicating the most severe abnormality. The total score ranges from 5 to 15, with higher scores indicating more severe liver disease 1.
Classification of Liver Disease Severity
The Child-Pugh score is used to classify patients into one of three categories:
- Class A: Scores 5-6, indicating mild liver disease
- Class B: Scores 7-9, indicating moderate liver disease
- Class C: Scores 10-15, indicating severe liver disease The Child-Pugh score has been widely adopted due to its simplicity and ease of use, despite its limitations, such as the subjective assessment of encephalopathy and ascites 1.
Clinical Applications
The score is used to predict mortality risk, with higher scores associated with increased mortality, and to guide treatment decisions, such as liver transplantation 1.
From the Research
Definition of Child-Pugh Score
- The Child-Pugh score is a system used to predict the survival of patients with liver cirrhosis and hepatocellular carcinoma (HCC) 2.
- It is a widely used scoring system that has been in use for approximately 30 years 2.
- The score is used to assess the severity of liver disease and predict mortality in patients with liver cirrhosis 3, 4, 5.
Components of Child-Pugh Score
- The Child-Pugh score takes into account various factors, including serum bilirubin, serum creatinine, international normalized ratio (INR) of prothrombin time, and the etiology of liver disease 2, 6.
- The score is calculated based on a combination of these factors, with different weights assigned to each variable 3, 4.
Comparison with MELD Score
- The Child-Pugh score has been compared to the Model for End-Stage Liver Disease (MELD) score, which is a more objective prognostic score that requires calculation software 3, 4, 5, 6.
- Studies have shown that the MELD score has a slightly higher predictive value than the Child-Pugh score in certain patient populations 2, 3, 4.
- However, the Child-Pugh score remains a simple and effective tool for prognostic assessment of cirrhotic patients and can still be used in clinical practice 4, 5.