Child-Pugh Score – Division of Gastroenterology, Hepatology & Nutrition

About two and a half million individuals in the United States have liver illness, which accounts for 1.4% of the U.S. population. Chronic liver and cirrhosis was the 12th major cause of mortality according to a survey in the U.S.

Several specific metabolic indicators can be used (e.g. antipyrin, monoethylglycine-xylide) to access the liver functioning. While these tests detect liver damage, for alcoholic cirrhosis and portal hypertension, Child-Pugh classification system is the most common clinical tool used for this purpose. The liver function is evaluated by using five indicators, including serum bilirubin, serum albumin, the timing of prothrombin, encephalopathy existence and ascites. The seriousness of the disease is then considered mild (5 to 6 points), moderate (7–9 points) or serious (10-15 points).

Child-Pugh score

The Child-Pugh score is a scheme to evaluate the forecast of chronic liver disease, mainly cirrhosis, including the necessary therapy intensity and the requirement of liver transplantation. It offers a prediction of the growing seriousness and anticipated survival of your liver disease. You can know your child’s Child-Pugh score by visiting

The ranking is also known as the Child-Pugh, the Child-Turcotte-Pugh (CTP) and Child Criteria.

Determination of Child-Pugh Score

In five clinical interventions of liver disease, the Pugh-Child rating is measured. Each metric is measured with a rating of 1, 2, or 3, and the 3 is the worst.

  • Bilirubin (total): A yellowish compound form as a result of hemoglobin breakdown present in the bile
  • Serum albumin: A protein present in the blood, synthesis in liver
  • INR or PT (prothrombin time): blood clotting time
  • Ascites: A fluid present in the peritoneal cavity
  • Encephalopathy (hepatic): A brain disorder caused due to liver disease
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For instance, the ascites measure would be awarded 1 point if the result is none.

  • The measurement would be 2 marks if the outcome of ascites was “mild / diuretic sensitive.”
  • The outcome would be 3 marks if the ascites were “moderate / diuretic refractory.”
  • Once results for each of the five clinical interventions are accessible, all scores are introduced to the consequence and Child-Pugh results are obtained.

Attempts have been produced to enhance Child-Pugh score precision by integrating additional liver function indicators (for example galactose clearance, green indocyanine, aminopyrine and lidocaine). But there was a restricted significance to those extra markers. There was also a restricted value in integrating traditional nutrition indicators into Child-Pugh score.

Since the five Child-Pugh values factors have been empirically chosen, not all autonomous prognostic predictors can be expected. For instance, time with albumin and prothrombin is a little redundant. With both factors included in a single rating, their own impact can affect.

Interpretation of Child-Pugh Score

The clinical interventions for Child-Pugh score are interpreted as follows:

Class A

  • Points from 5 to 6
  • Lesser serious hepatic illness
  • Survival rate one to five years i.e. 95%


Class B

  • Points from 7 – 9
  • Mildly serious hepatic diseases
  • Survival rate one to five years; 75%

Class C

  • Points between 10 to 15
  • More serious liver illness
  • Survival rate one to five years (50%)

The prediction gets worse as A->C increases and is shown by worse decompensation. The classification / score of Child has however been mainly substituted by MELD classification for hepatic transplantation. It is a gravity index that shows the danger and urgency of mortality. It determines the need for liver transplantation quickly.

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The MELD score

In adult patients for liver transplantation, the model for end-stage liver disease or MELD score has been used. This is a seriousness index that shows the danger and urgency of mortality. It determines the timing of liver transplantation.

The MELD score is calculated with a mathematical formula based on three outcomes from a laboratory: To be in the United Network for Organ Sharing (UNOS) transplant list you should have a MELS score.

  • International Normalized Ratio (INR)
  • Total bilirubin
  • Creatinine

The 4 MELD levels are:

  • Equal to 10 or Less than 10 (less ill)
  • 11 to 18
  • 19 to 24
  • Greater than or equal to 25 (severely ill)

Patients with liver disease at the end of the stage are continuously evaluated:

  • Fewer or 10 (less ill): lab reports should be done every year
  • 11 to 18: lab reports should be done every 90 days
  • 19 to 24: lab reports should be done every 30 days
  • Equal to 25 or more than that: lab reports must be done after every 7 days

The person shifts the transplant list upward as the MELD score rises.

The PELD score

The PELD score is a variant of the MELD score for kids under 12 years old. It is used to prioritize liver transplantation patients like the MELD score.


The Child-Pugh score for liver disease prognosis was first suggested by Child and Turcotte of the University of Michigan in 1964. It was further changed to include prothrombin time (PT) by Pugh in 1972. Most clinicians are now using the INR rather than PT of the patient.

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A Child-Pugh rating for the hepatitis insufficiency prognosis is a part of the hepatitis diagnosis and therapy part. It acts as a hepatic marker and helps to determine the suitable therapy.

In liver disease at the end of this stage, the functions of the liver decrease until the only way to transplant the liver are. You need a MELD score or PELD score if you are under the era of 12 to enter the UNOS transplantation list.

Although the first such scheme to stratify the severity of end stage liver disease, the Child-Pugh rating scheme has now become less often used. The End-Stage Liver Disease (MELD) model is used to evaluate liver transplantation patients, although they appear to be more or less equal in the two results.

Period mortality evaluation in hepatic dysfunction patients may be more precise in the MELD score. The rating is based on a global standard proportion (INR) depending on a linear regression system depending on serum bilirubin, creatinine concentrations, and INR (International Normalization Ratio).

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