What score is used to assess the degree of liver cirrhosis?

Assessment of Liver Cirrhosis Severity

The Child-Pugh score is the primary tool used to assess the degree of liver cirrhosis, classifying patients into three classes (A, B, or C) based on five clinical and laboratory parameters. 1

Primary Scoring System: Child-Pugh Score

The Child-Pugh classification remains the most widely adopted scoring system for assessing cirrhosis severity due to its simplicity, ease of bedside calculation, and inclusion of both objective laboratory values and clinical assessments. 1, 2

Five Components (Each Scored 1-3 Points):

• Encephalopathy: None (1 point), Grade 1-2 (2 points), Grade 3-4 (3 points) 1, 2
• Ascites: Absent (1 point), Slight (2 points), Moderate (3 points) 1, 2
• Bilirubin: 1-2 mg/dL (1 point), 2-3 mg/dL (2 points), >3 mg/dL (3 points) 1, 2
• Albumin: >3.5 g/dL (1 point), 2.8-3.5 g/dL (2 points), <2.8 g/dL (3 points) 1, 2
• Prothrombin time/INR: 1-4 seconds or INR <1.7 (1 point), 4-6 seconds or INR 1.7-2.3 (2 points), >6 seconds or INR >2.3 (3 points) 1, 2

Classification and Prognosis:

• Class A (5-6 points): Compensated cirrhosis with 90% 5-year survival 1, 2
• Class B (7-9 points): Decompensated cirrhosis with 80% 5-year survival 1, 2
• Class C (10-15 points): Decompensated cirrhosis with >33% mortality within 1 year 1, 2

Alternative Scoring System: MELD Score

The Model for End-Stage Liver Disease (MELD) serves as a complementary objective scoring system, particularly valuable for liver transplantation prioritization. 1

MELD Characteristics:

• Calculation: Uses three laboratory values only—serum bilirubin, creatinine, and INR 1
• Range: Numerical scale from 6 (less ill) to 40 (gravely ill) for patients ≥12 years 1
• Advantages: Completely objective, includes renal function assessment, continuous scale without subjective clinical parameters 1
• Limitations: Does not capture ascites or encephalopathy; creatinine can be unreliable in cirrhosis; not validated for non-transplant populations 1

It remains unclear whether MELD is superior to Child-Pugh for predicting survival in general cirrhosis populations. 1

Critical Additional Assessment: Portal Hypertension

You must evaluate for clinically significant portal hypertension alongside any liver scoring system, as neither Child-Pugh nor MELD adequately captures this critical prognostic factor. 1, 3

Signs to Assess:

• Esophagogastric varices (via endoscopy or cross-sectional imaging) 1
• Splenomegaly and splenorenal shunts 1
• Thrombocytopenia (surrogate marker) 1
• Abdominal collaterals and recanalized umbilical vein 1

Supplementary Tool: Albumin-Bilirubin (ALBI) Grade

The ALBI score uses only serum albumin and bilirubin levels, eliminating subjective variables, and is particularly helpful for predicting survival in patients with stable decompensated cirrhosis and hepatocellular carcinoma. 1, 2

Clinical Application Algorithm

For routine cirrhosis assessment: Calculate Child-Pugh score every 6 months for all cirrhotic patients. 4

For transplant evaluation: Use MELD score when Child-Pugh >7 (Class B/C) or MELD >10, or when first major complication develops (ascites, variceal bleeding, encephalopathy). 1

For hepatocellular carcinoma: Use Child-Pugh to determine surgical resection candidacy; consider ALBI grade for additional prognostic information. 2, 5

Important Caveats

The development of any decompensation event (ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepatorenal syndrome) dramatically worsens prognosis, reducing 5-year survival to only 20-50% regardless of initial score. 1, 2 Patients with spontaneous bacterial peritonitis have <50% 1-year survival, while type I hepatorenal syndrome carries a median survival of <2 weeks, warranting expedited transplant referral. 1

A 2-point worsening in Child-Pugh score or progression from Class A to B accurately indicates worsening health status and increased mortality risk. 2