About the Child-Pugh Score
The Child-Pugh score (also called Child-Turcotte-Pugh or CTP) was originally developed by Child and Turcotte in 1964 and modified by Pugh in 1973 to assess the prognosis of patients with cirrhosis and guide surgical risk estimation, particularly for portosystemic shunt surgery. It classifies hepatic reserve into three categories — Class A (well-compensated), Class B (significant functional compromise), and Class C (decompensated).
Scoring Criteria
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Bilirubin | <2 mg/dL | 2–3 mg/dL | >3 mg/dL |
| Albumin | >3.5 g/dL | 2.8–3.5 g/dL | <2.8 g/dL |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | None | Mild | Mod–Severe |
| Encephalopathy | None | Grade I–II | Grade III–IV |
Child-Pugh Classification
| Class | Score | 1-Yr Survival | 2-Yr Survival | Perioperative Mortality |
|---|---|---|---|---|
| A | 5–6 | 100% | 85% | 10% |
| B | 7–9 | 81% | 57% | 30% |
| C | 10–15 | 45% | 35% | 82% |
Child-Pugh vs MELD
The MELD score replaced Child-Pugh for organ allocation due to its fully objective (laboratory-only) inputs and better prediction of short-term mortality. However, Child-Pugh remains clinically valuable for surgical risk assessment, hepatocellular carcinoma staging (Barcelona Clinic Liver Cancer criteria), and decisions about treatment tolerability (e.g., chemotherapy, procedures). Use both in clinical practice for complementary information.
References
Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649.
Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1–85.