BackTable / VI / Tool

Child-Pugh Score Calculator

The Child-Pugh Score Calculator is a valuable clinical tool used by healthcare professionals to assess the severity of liver disease and to predict the prognosis in patients with chronic liver conditions, such as cirrhosis. It was first introduced in 1973 by the British physician Dr. Child and later modified by Dr. Pugh in 1975. It employs a simple algorithm based on five clinical variables to categorize liver disease into one of three classes, with each class signifying a different level of severity. The five variables include serum bilirubin, serum albumin, prothrombin time or international normalized ratio (INR), ascites, and hepatic encephalopathy. Each variable is assigned a point value ranging from 1 to 3, depending on the severity of the abnormality, and then summed together for a final score to determine the classification of severity.

The Child-Pugh Score Calculator is crucial for a variety of purposes, such as determining the appropriateness of invasive procedures, evaluating the risk of surgical intervention, and guiding clinical decision-making for treatment options. In addition, it can help clinicians estimate the patient's life expectancy and allocate resources more effectively. After using the calculator, keep reading to further understand the results, clinical applications, and limitations of the Child-Pugh Score Calculator.

Child-Pugh Score Calculator Results

Based on bilirubin, albumin, prothrombin time (INR), ascites, and encephalopathy the Child-Pugh Score calculator puts patients into one of three risk classes:

• Class A (5 to 6 points): Life expectancy is 15-20 years. Perioperative mortality rate is 10%.
• Class B (7 to 9 points): Life expectancy is 4-14 years. Perioperative mortality rate is 30%.
• Class C (10 to 15 points): Life expectancy is 1-3 years. Perioperative mortality rate is 82%.

Clinical Applications of the Child-Pugh Score Calculator

The Child-Pugh Score is commonly used in practice to help guide care decisions related such as elective abdominal surgery or transjugular intrahepatic portosystemic shunt (TIPS).

Child-Pugh Class A patients are generally considered safe candidates for elective surgery.
Child-Pugh Class B patients are at higher risk, but can undergo surgery after medical optimization.
In Child-Pugh Class C patients, elective surgeries are not considered a safe option even after medical optimization.

In Interventional Oncology, Child-Pugh Score can also be useful in determining the appropriate treatment method for hepatocellular carcinoma (HCC). Placing the Child-Pugh Score into the patient’s clinical context, in addition to understanding the goals of treatment and extent of locoregional therapy, can help shape a patient’s individualized HCC treatment plan.

One of the many HCC treatment algorithms that consider Child-Pugh Score can be found here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059812/figure/f2-conc-21-e480/

Limitations of the Child-Pugh Score Calculator

The Child-Pugh Score calculator, despite its ease of use, has important limitations. One limitation is that the risk model uses low-resolution cut-off values in scoring. There is no evidence that these cut-off values define significant changes in mortality, so a small change in value can disproportionately modify the mortality risk determined by the Child-Pugh Score. Another limitation is that some of the variables in the calculator are based on subjective factors. Specifically, subjective interpretation of ascites and encephalopathy may yield different assessments. A third limitation is that Child-Pugh does not consider other prognostic factors like renal function. These limitations are mostly accounted for in the MELD calculator, however the MELD score requires a different set of clinical inputs.

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on the Child-Pugh Score Calculator and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 16 Pressure-Directed Therapy in Y90 with Dr. Charles Nutting and Dr. Nainesh Parikh

00:00 / 01:04

References

[1] Durand, F., & Valla, D. (2005). Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD. Journal of Hepatology,42(1). doi:10.1016/j.jhep.2004.11.015
[2] Tsoris, A. (2020, May 17). Use Of The Child Pugh Score In Liver Disease. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK542308/
[3] Molla, N., AlMenieir, N., Simoneau, E., Aljiffry, M., Valenti, D., Metrakos, P., Boucher, L. M., & Hassanain, M. (2014). The role of interventional radiology in the management of hepatocellular carcinoma. Current Oncology, 21(3), e480–e492. https://doi.org/10.3747/co.21.1829

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.