Child-Pugh Score
Classification of severity of cirrhosis and hepatic dysfunction
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Why use it
Prognostication in cirrhosis. Guides surgical risk assessment in cirrhotic patients. Determines candidacy for procedures (TIPS, hepatic resection). Complements MELD for clinical decision-making.
About
The Child-Pugh score classifies the severity of cirrhosis using five clinical measures: bilirubin, albumin, INR (or PT prolongation), ascites, and hepatic encephalopathy. It categorizes patients into Class A (well-compensated), B (significant functional compromise), or C (decompensated), each with distinct prognostic and surgical risk implications.
When to use
- Prognostication and follow-up of cirrhotic patients
- Pre-operative risk assessment in patients with liver disease
- TIPS candidacy evaluation
- Assessment of hepatic functional reserve
Formula
Pearls & pitfalls
- Child-Pugh is simpler than MELD but less objective (ascites and encephalopathy are subjective).
- Not used for UNOS transplant allocation (MELD-Na is used instead).
- Albumin is affected by nutritional status and acute illness — interpret in context.
- INR may be elevated by anticoagulants, falsely increasing the score.
- Class C patients are generally not surgical candidates except for transplant.
Next steps
Class A (5-6): Good hepatic function, low surgical risk (~10% perioperative mortality). Class B (7-9): Significant compromise, moderate surgical risk (~30%). Class C (10-15): Decompensated, high risk (~80%), consider transplant evaluation.
Evidence
Original description by Child and Turcotte (1964) for surgical risk. Modified by Pugh et al. (1973) replacing nutritional status with PT/INR. Widely validated for prognostication in cirrhosis. 1-year survival: Class A ~100%, Class B ~80%, Class C ~45%.