The Child-Pugh score is a scoring system that measures the severity of chronic liver disease, including cirrhosis.

Usage

This score was initially devised by Child and Turcotte in 1964 to risk stratify patients with portal hypertension undergoing shunt surgery. It was revised in 1972 by Pugh with the replacement of nutritional status with the more objective INR/prothrombin ^4,5. Subsequently, it has been a commonly used tool, along with the MELD score, to assess the prognosis of cirrhosis patients ⁵.

Higher Child-Pugh scores indicate worsening liver function and give treating teams an idea of "liver comorbidity" and "liver reserve". This can be useful when planning interventions on the liver since liver failure is the main cause of death after liver resection ¹. 

Classification

The score is composed of several categories:

• total bilirubin, μmol/L (mg/dL)

  • <34: 1 point

  • 34-50: 2 points

  • >50: 3 points

• serum albumin, g/L

  • >35: 1 point

  • 28-35: 2 points

  • <28: 3 points

• INR or prothrombin time

  • <1.7 or <4: 1 point

  • 1.7-2.3 or 4-6: 2 points

  • >2.3 or >6: 3 points

• presence of ascites

  • none: 1 point

  • mild: 2 points

  • moderate to severe: 3 points

• presence of hepatic encephalopathy

  • none: 1 point

  • grades I-II (or suppressed with medication): 2 points

  • grades III-IV (or refractory): 3 points

The point scores are then added up and classified as:

• class A: 5-6 points

• class B: 7-9 points

• class C: 10-15 points

If the patient has primary biliary cholangitis or sclerosing cholangitis then bilirubin is classified as ²:

• <68: 1 point

• 68–170: 2 points 

• >170: 3 points