Child-Pugh score 739302 222420720 2008-06-29T07:08:38Z Jfdwolff 46555 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]] [[de:Child-Pugh-Score]] [[es:Escala Child-Pugh]] [[pl:Skala Childa-Pugha]]