5
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100
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85
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5
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1
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100
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85
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The Child-Pugh Score (also known as the Child-Turcotte-Pugh score) is a classic clinical scoring system used to assess the severity of chronic liver disease and cirrhosis. Originally developed by Child and Turcotte in 1964 and modified by Pugh in 1973, this score uses five clinical and laboratory parameters to classify patients into three classes (A, B, and C) of increasing severity. Despite the more recent development of the MELD score, the Child-Pugh classification remains widely used in clinical practice for prognostic assessment, surgical risk stratification, and treatment decision-making.
The five parameters are total bilirubin, serum albumin, INR (or prothrombin time prolongation), ascites, and hepatic encephalopathy. Each parameter is scored 1, 2, or 3 points based on severity, yielding a total score from 5 to 15. Class A (5-6 points) indicates well-compensated cirrhosis with excellent 1-year survival approaching 100%. Class B (7-9 points) indicates significant functional compromise with approximately 80% 1-year survival. Class C (10-15 points) indicates decompensated cirrhosis with only about 45% 1-year survival.
The Child-Pugh score has particular value in surgical risk assessment. Class A patients generally tolerate abdominal surgery well, with perioperative mortality rates of approximately 10%. Class B patients face moderate surgical risk with 30% perioperative mortality. Class C patients have prohibitive surgical risk with mortality rates exceeding 80% for major abdominal operations. These risk estimates guide decisions about whether surgical intervention is appropriate and what degree of preoperative optimization is needed.
In hepatocellular carcinoma (HCC) management, the Child-Pugh class is integral to the Barcelona Clinic Liver Cancer (BCLC) staging system, which guides treatment selection. Curative treatments (resection, ablation, transplantation) are generally offered only to Child-Pugh A patients. Transarterial chemoembolization (TACE) is appropriate for Child-Pugh A and selected B patients. Child-Pugh C patients with HCC are generally candidates only for best supportive care or transplantation if eligible. This integration underscores the importance of hepatic reserve in determining which therapies patients can safely tolerate.
Despite its longevity and widespread use, the Child-Pugh score has well-recognized limitations. The ascites and encephalopathy components are subjective, creating interobserver variability. The score uses arbitrary cutoff values for laboratory parameters. It has a ceiling effect, with many severely ill patients clustering in Class C without further discrimination. These limitations led to the development of the MELD score, which uses only objective laboratory values and provides continuous rather than categorical risk stratification. However, the Child-Pugh score's inclusion of clinical parameters (ascites, encephalopathy) captures aspects of liver disease not reflected in MELD.
In practice, clinicians use both scoring systems complementarily. The MELD score is preferred for transplant allocation and short-term mortality prediction. The Child-Pugh classification excels in communicating overall disease severity to patients and families, guiding drug dosing adjustments in liver disease, assessing surgical risk, and directing HCC treatment selection. Together, they provide a comprehensive assessment of liver disease severity and prognosis.
Five parameters are scored 1-3 points each: bilirubin, albumin, INR, ascites severity, and hepatic encephalopathy grade. Total score ranges from 5 to 15. Class A (5-6): well-compensated, ~100% 1-year survival. Class B (7-9): significant compromise, ~80% survival. Class C (10-15): decompensated, ~45% survival.
Class A patients generally tolerate surgery and intensive treatments. Class B patients require careful risk-benefit assessment. Class C patients have decompensated cirrhosis with very limited treatment options and high mortality. The class guides drug dosing, surgical risk assessment, and HCC treatment selection.
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Score 5 (all parameters normal). Class A with excellent prognosis.
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Score 13. Decompensated cirrhosis with 45% 1-year survival.
A scoring system (5-15 points) classifying cirrhosis severity into three classes (A, B, C) using bilirubin, albumin, INR, ascites, and encephalopathy. It predicts survival and guides treatment decisions.
Child-Pugh uses 5 parameters (2 subjective) and creates categories. MELD uses 3 objective labs and creates a continuous score. MELD is better for transplant allocation; Child-Pugh is useful for clinical staging and drug dosing.
Compensated cirrhosis (Class A) has preserved liver function without major complications. Decompensated cirrhosis (Class B/C) features complications such as ascites, variceal bleeding, encephalopathy, or jaundice.
Class A: ~10% perioperative mortality, acceptable surgical risk. Class B: ~30% mortality, proceed with caution. Class C: >80% mortality, surgery generally contraindicated except emergencies or transplantation.
Many drugs metabolized by the liver require dose reduction in Child-Pugh B and further reduction or avoidance in Class C. Drug labels often specify dosing adjustments by Child-Pugh class.
Grade I: mild confusion, sleep disturbance. Grade II: drowsiness, moderate confusion, asterixis. Grade III: marked confusion, somnolence, disorientation. Grade IV: coma. Grades I-II score 2 points; III-IV score 3 points.
None: 1 point. Mild-moderate (responsive to diuretics): 2 points. Severe/refractory (not responsive to diuretics, requiring paracentesis): 3 points. Assessment is clinical and may be confirmed by ultrasound.
While MELD is used for organ allocation priority, Child-Pugh Class B and C patients are generally considered transplant candidates. Class A patients usually do not need transplantation. The score helps determine when to refer for transplant evaluation.
Yes. Patients can progress from A to B to C as liver disease worsens, or improve (e.g., after alcohol cessation, antiviral treatment) from C to B or B to A. Regular reassessment guides evolving management plans.
Albumin is produced exclusively by the liver and reflects synthetic function. Low albumin (<2.8 g/dL) indicates severely impaired hepatic synthesis and is associated with ascites, edema, and poor overall prognosis.
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