What is the Child-Pugh score?

II. Criteria

  1. Total Serum Bilirubin
    1. Bilirubin <2 mg/dl: 1 point
    2. Bilirubin 2-3 mg/dl: 2 points
    3. Bilirubin >3 mg/dl: 3 points
  2. Serum Albumin
    1. Albumin >3.5 g/dl: 1 point
    2. Albumin 2.8 to 3.5 g/dl: 2 point
    3. Albumin <2.8 g/dl: 3 point
  3. INR
    1. INR <1.70: 1 point
    2. INR 1.71 to 2.20: 2 point
    3. INR >2.20: 3 point
  4. Ascites
    1. No Ascites: 1 point
    2. Ascites controlled medically: 2 point
    3. Ascites poorly controlled: 3 point
  5. Encephalopathy
    1. No Encephalopathy: 1 point
    2. Encephalopathy controlled medically: 2 point
    3. Encephalopathy poorly controlled: 3 point

III. Interpretation

  1. Child Class A: 5 to 6 points
    1. Life expectancy: 15 to 20 years
    2. Abdominal surgery peri-operative mortality: 10%
  2. Child Class B: 7 to 9 points
    1. Indicated for liver transplantation evaluation
    2. Abdominal surgery peri-operative mortality: 30%
  3. Child Class C: 10 to 15 points
    1. Life expectancy: 1 to 3 years
    2. Abdominal surgery peri-operative mortality: 82%
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Summary


The Child-Pugh score, or the Child-Pugh grade, can be used in patients with liver cirrhosis to assess the severity of the clinical condition. Five variables are considered (severity of ascites and of encephalopathy, abnormality in the serum bilirubin, serum albumin and clotting times), and a score (of between 1 and 3) is accordingly assigned to each of these factors. The sum of the scores provides the Child-Pugh score, which corresponds to a Child-Pugh grade (or Child’s grade) of A, B or C. 

This grade is used as a general means to verify the prognosis of the patient. For example, it can be used to determine the risk to a patient with regard to possible surgery, and also, to suggest the perceived survival of the patient over a period of time. Pharmaceutical manufacturers may use the Child-Pugh grade to suggest dose reductions, or to contraindicate the use of the drug, dependent on the degree of dysfunction of the cirrhotic liver. 

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