Child–Pugh score
In medicine, specifically gastroenterology, the Child–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.
Scoring
The score employs five clinical measures of liver disease. Each measure is scored 1–3, with 3 indicating most severe derangement.Either the prothrombin time or INR should be used to calculate the Child-Pugh score, not both.
| Measure | 1 point | 2 points | 3 points |
| Total bilirubin, μmol/L | < 34 | 34–50 | > 50 |
| Serum albumin, g/dL | > 3.5 | 2.8–3.5 | < 2.8 |
| Prothrombin time, prolongation | < 4.0 | 4.0–6.0 | > 6.0 |
| INR | < 1.7 | 1.7–2.3 | > 2.3 |
| Ascites | - | Mild | Moderate to severe |
| Hepatic encephalopathy | - | Grade I–II | Grade III–IV |
In primary sclerosing cholangitis and primary biliary cholangitis, some use a modified Child Pugh score where 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 and the upper limit for 2 points is 170 μmol/L.
Mnemonic: "Pour INH Another Beer At Eleven" for PT, INR, Ascites, Bilirubin, Albumin, Encephalopathy.
"PIA- BEA": for PT, INR, Ascites, Bilirubin, Encephalopathy, Albumin.
"ABCDE" for Albumin, Bilirubin, Coagulation, Drum abdomen, Encephalopathy.
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 | 80% | 60% |
| 10–15 | C | 45% | 35% |
Related scoring systems
- MELD Score
- MELD-Plus
History