Friday November 10, 2006
Assessment of cirrhosis !! - Part 1 - Child-Pugh score

Editors' note: We will run this pearl on assessment of cirrhosis in 3 parts.

Part 1 - The Child-Turcotte-Pugh (CPS) score.
Part 2 - "model for end stage liver disease" (MELD) score and
Part 3 to compare both scores.

We are thankful to Dr. Richard Saval, Associate Director, Surgical Intensive Care Unit, Maimonides Medical Center and Assistant Professor of Medicine, Mt. Sinai School of Medicine, NY in helping us out in this series of pearl.


Evaluating prognosis in Cirrhosis via Child-Turcotte-Pugh (CPS) score

In 1964 Dr C.G. Child and Dr J.G. Turcotte from the University of Michigan first proposed the scoring system of prognosis in Cirrhosis. In 1972, it was modified by Dr. Pugh as he replaced criterion of nutritional status with the INR.


1 point to lower value
2 points to middle value and
3 points to highest value

1. Total Bilirubin (mg/dL) less than 2 or 2-3 or more than 3

2. Albumin (g/L) more than 35 or 30-35 or less than 30

3. INR 1.7 or 1.7- 2.2 or more than 2.2

4. Ascites None or Controlled with medication or Refractory

5. Hepatic encephalopathy None or Grade I-II (or controlled with medication) or Grade III-IV(coma)


Interpretation

Class A - if Points are 5-6, life expectancy is 15-20 years and Perioperative mortality is about 10%.

Class B - if Points are 7-9, life expectancy is 10-15 years and Perioperative mortality is about 30%.

Class C - if Points are 10-15, life expectancy is 1-3 months and Perioperative mortality is about 82%