Child-Pugh Score (Hepatic Dz)
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Serum bilirubin <20 mg/L 20-30 mg/L >30 mg/L
Serum albumin >35 g/L 28-35 g/L <28 g/L
Prothrombin time (INR) <1.7 1.7-2.2 >2.2
Presence of hepatic encephalopathy None Trey 1-2 (or suppressed with medication) Trey 3-4
Presence of ascites None Mild/Moderate (detectable or suppressed with medication) Severe (tense)
R e s u l t s
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Child-Pugh Score
 
Survival
 
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Child-Pugh Score (Hepatic Dz)

The Pugh modification of the Child score is presented here.

This scoring system is well validated for determining survival of patients with cirrhosis of the liver.

Factors considered in this score are:

  • Serum bilirubin
    • <2 mg/dL [1 pt]
    • 2-3 mg/dL [2 pts]
    • >3 mg/dL [3 pts]
  • Serum albumin
    • >3.5 g/dL [1 pt]
    • 2.8-3.5 g/dL [2 pts]
    • <2.8 g/dL [3 pts]
  • Prothrombin time (INR)
    • <1.7 [1 pt]
    • 1.7-2.2 [2 pts]
    • >2.2 [3 pts]
  • Presence of hepatic encephalopathy
    • None [1 pt]
    • Trey 1-2 (or suppressed with medication) [2 pts]
    • Trey 3-4 [3 pts]
  • Presence of ascites
    • None [1 pt]
    • Mild/Moderate (detectable or suppressed with medication) [2 pts]
    • Severe (tense) [3 pts]

Note on encephalopathy grading:

  • Grade 1: Sleep disturbance, decreased concentration, anxiety, depression or irritability
  • Grade 2: Drowsiness, poor short term memory, disorientation, disinhibition
  • Grade 3: Somonolence, confusion, amnesia, abnormal behavior (anger, paranoia)
  • Grade 4: Coma

The score is summed and a Child Class, which relates to mortality is assigned.

Score Child Class 1 yr survival 2 yr survival
5-6 A 100% 85%
7-9 B 81% 57%
>9 C 45% 35%

Reference:

  • Child CG, Turcotte JG. Surgery and Portal Hypertension. In: Child CG, ed. The Liver and Portal Hypertension. Philadelphia, PA: Saunders; 1964:50-64.
  • Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology. 1994;19(6):1513-20.
  • Pugh RN, Murray-lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-9.