Child-Pugh score
Encyclopedia
In medicine
(gastroenterology
), the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis
. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation
.
Different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
In primary sclerosing cholangitis
(PSC) and primary biliary cirrhosis
(PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels. The upper limit for 1 point is 68 μmol/l (4 mg/dl) and the upper limit for 2 points is 170 μmol/l (10 mg/dl).
(MELD) is used increasingly to assess patients for liver transplantation, although both scores seem to be more or less equivalent.
first proposed the scoring system in 1964. It was modified by Pugh et al in 1972. They replaced Child's criterion of nutritional status with the prothrombin time
or INR, and thus eliminated the most subjective part of the score.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
(gastroenterology
Gastroenterology
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...
), the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis
Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation
Liver transplantation
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...
.
Scoring
The score employs five clinical measures of liver disease. Each measure is scored 1-3, with 3 indicating most severe derangement.| Measure | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin Bilirubin Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases... , μmol/l (mg/dl) |
<34 (<2) | 34-50 (2-3) | >50 (>3) |
| Serum albumin Serum albumin Serum albumin, often referred to simply as albumin is a protein that in humans is encoded by the ALB gene.Serum albumin is the most abundant plasma protein in mammals. Albumin is essential for maintaining the osmotic pressure needed for proper distribution of body fluids between intravascular... , g/l |
>35 | 28-35 | <28 |
| PT INR | <1.7 | 1.71-2.20 | > 2.20 |
| Ascites Ascites Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver... |
None | Mild | Severe |
| Hepatic encephalopathy Hepatic encephalopathy Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma as a result of liver failure. In the advanced stages it is called hepatic coma or coma hepaticum... |
None | Grade I-II (or suppressed with medication) | Grade III-IV (or refractory) |
Different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
In primary sclerosing cholangitis
Primary sclerosing cholangitis
Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer...
(PSC) and primary biliary cirrhosis
Primary biliary cirrhosis
Primary biliary cirrhosis, often abbreviated PBC, is an autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts within the liver. When these ducts are damaged, bile builds up in the liver and over time damages the tissue. This can lead to scarring,...
(PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels. The upper limit for 1 point is 68 μmol/l (4 mg/dl) and the upper limit for 2 points is 170 μmol/l (10 mg/dl).
Interpretation
Chronic liver disease is classified into Child-Pugh class A to C, employing the added score from above.| Points | Class | One year survival | Two year survival |
| 5-6 | A | 100% | 85% |
| 7-9 | B | 81% | 57% |
| 10-15 | C | 45% | 35% |
Other scoring systems
Although the Child-Turcotte scoring system was the first of its kind in stratifying the seriousness of end-stage liver disease, it is by no means the only one. The Model for End-Stage Liver DiseaseModel for End-Stage Liver Disease
The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt procedure, and was...
(MELD) is used increasingly to assess patients for liver transplantation, although both scores seem to be more or less equivalent.
History
Dr C.G. Child and Dr J.G. Turcotte of the University of MichiganUniversity of Michigan
The University of Michigan is a public research university located in Ann Arbor, Michigan in the United States. It is the state's oldest university and the flagship campus of the University of Michigan...
first proposed the scoring system in 1964. It was modified by Pugh et al in 1972. They replaced Child's criterion of nutritional status with the prothrombin time
Prothrombin time
The prothrombin time and its derived measures of prothrombin ratio and international normalized ratio are measures of the extrinsic pathway of coagulation. This test is also called "ProTime INR" and "INR PT". They are used to determine the clotting tendency of blood, in the measure of warfarin...
or INR, and thus eliminated the most subjective part of the score.