Child-Pugh score
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2008-06-29T07:08:38Z
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Reverted edits by [[Special:Contributions/64.126.179.90|64.126.179.90]] ([[User talk:64.126.179.90|talk]]) to last version by DOI bot
In [[medicine]] ([[gastroenterology]]), the '''Child-Pugh score''' (sometimes the '''Child-Turcotte-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.
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
|bgcolor="#aaaadd"| '''Measure'''
|bgcolor="#aaaadd"| '''1 point'''
|bgcolor="#aaaadd"| '''2 points'''
|bgcolor="#aaaadd"| '''3 points'''
|bgcolor="#aaaadd"| '''units'''
|-
| ''[[Bilirubin]] (total)''
| <34 (<2)
| 34-50 (2-3)
| >50 (>3)
| μmol/l (mg/dl)
|-
| ''[[Serum albumin]]''
| >35
| 28-35
| <28
| g/l
|-
| ''[[INR]]''
| <1.7
| 1.71-2.20
| > 2.20
| ''no unit''
|-
| ''[[Ascites]]''
| None
| Suppressed with medication
| Refractory
| ''no unit''
|-
| ''[[Hepatic encephalopathy]]''
| None
| Grade I-II (or suppressed with medication)
| Grade III-IV (or refractory)
| ''no unit''
|}
It should be noted that different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
In [[primary sclerosing cholangitis]] (PSC) and [[primary biliary cirrhosis]] (PBC), 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 (4 mg/dl) and the upper limit for 2 points is 170 μmol/l (10 mg/dl).
==Interpretation==
Chronic liver disease is classified into Child-Pugh class A to C, employing the added score from above.
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
|bgcolor="#aaaadd"| '''Points'''
|bgcolor="#aaaadd"| '''Class'''
|bgcolor="#aaaadd"| '''One year survival'''
|bgcolor="#aaaadd"| '''Two year survival'''
|-
| 5-6
| A
| 100%
| 85%
|-
| 7-9
| B
| 81%
| 57%
|-
| 10-15
| C
| 45%
| 35%
|}
==Other scoring systems==
Although the Child-Turcotte scoring system was the first of its kind in stratifying the seriousness of end-stage liver disease, it is by no means the only one. The [[Model for End-Stage Liver Disease]] (MELD) is used increasingly to assess patients for liver transplantation, although both scores seem to be more or less equivalent[http://organtx.org/tx/ctp-meld.htm].
==History==
Dr C.G. Child and Dr J.G. Turcotte of the [[University of Michigan]] first proposed the scoring system in [[1964]].<ref>Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.</ref> It was modified by Pugh in [[1972]] <ref>{{cite journal |author=Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R |title=Transection of the oesophagus for bleeding oesophageal varices |journal=The British journal of surgery |volume=60 |issue=8 |pages=646–9 |year=1973 |pmid=4541913|doi=10.1002/bjs.1800600817}}</ref>. He replaced Child's criterion of nutritional status with the [[prothrombin time]] or [[INR]], and thus eliminated the most subjective part of the score.
==References==
{{Reflist}}
==External links==
* [http://homepage.mac.com/sholland/contrivances/childpugh.html Online Child-Pugh calculator]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Medical scoring system]]
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