The Child-Pugh Score is a clinical scoring system used to assess the prognosis of patients with cirrhosis and advanced chronic liver disease. Originally developed in the 1960s to predict mortality after surgical treatment of portal hypertension, it has since become one of the most widely used tools for estimating disease severity, survival, and guiding management in cirrhotic patients.
The score combines five clinical and laboratory parameters—bilirubin, albumin, prothrombin time/INR, ascites, and hepatic encephalopathy—to categorize patients into three classes (A, B, or C). These classes correlate with expected survival rates and perioperative mortality, making the Child-Pugh Score highly relevant in clinical decision-making and transplant evaluation.
Components of the Child-Pugh Score
Each parameter is assigned a score of 1 to 3, with higher points indicating greater severity of liver dysfunction.
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Total bilirubin (mg/dL) | < 2 | 2–3 | > 3 |
| Serum albumin (g/dL) | > 3.5 | 2.8–3.5 | < 2.8 |
| Prothrombin time prolongation (seconds) or INR | < 4 sec or INR < 1.7 | 4–6 sec or INR 1.7–2.3 | > 6 sec or INR > 2.3 |
| Ascites | Absent | Slight/mild (controlled with medication) | Moderate/severe (poorly controlled) |
| Hepatic encephalopathy | None | Grade I–II (mild to moderate) | Grade III–IV (severe) |
Interpretation
The total Child-Pugh score is calculated by summing the points for each parameter (range: 5–15). Patients are then classified into three prognostic categories:
- Class A (5–6 points): Well-compensated cirrhosis; 1-year survival ≈ 100%, 2-year survival ≈ 85%.
- Class B (7–9 points): Significant functional compromise; 1-year survival ≈ 80%, 2-year survival ≈ 60%.
- Class C (10–15 points): Decompensated cirrhosis; 1-year survival ≈ 45%, 2-year survival ≈ 35%.
Higher classes (B and C) indicate more advanced disease and poorer prognosis. Class C patients are typically considered for liver transplantation.
Clinical Significance
The Child-Pugh Score plays a key role in the management of cirrhosis:
- Prognosis estimation: Provides survival predictions that help clinicians counsel patients and families.
- Therapeutic decision-making: Influences whether invasive procedures, surgery, or transjugular intrahepatic portosystemic shunt (TIPS) are appropriate.
- Transplant evaluation: Child-Pugh Class C patients are prioritized for liver transplantation.
- Drug dosing: Certain medications metabolized by the liver are adjusted according to Child-Pugh classification.
- Research and clinical trials: Widely used as a stratification tool in hepatology research.
Indications for Use
The Child-Pugh Score should be applied in:
- Patients with cirrhosis of any etiology (alcoholic, viral, metabolic, autoimmune).
- Hospitalized patients with complications such as ascites, variceal bleeding, or encephalopathy.
- Preoperative assessments for patients with known liver disease.
- Oncology settings when evaluating hepatocellular carcinoma treatment eligibility.
Limitations
While widely used, the Child-Pugh Score has notable limitations:
- Subjectivity: Ascites and encephalopathy grading depend on clinical judgment and may vary between observers.
- Broad categories: Patients within the same class may have very different outcomes.
- Limited accuracy: The Model for End-Stage Liver Disease (MELD) score is now often preferred for transplant prioritization due to greater objectivity.
- Static snapshot: The score reflects current status but does not account for rapid changes in disease course.