Child-Pugh score

What it is

The Child-Pugh score is the clinical score used to quantify the severity of chronic liver disease or cirrhosis. It is the answer to the bedside question asked of the elderly chronic active alcoholic who comes with progressive abdominal distension, whose liver is impalpable on palpation and who has splenomegaly: the diagnosis is chronic liver disease or cirrhosis, and the score that quantifies its severity is the Child-Pugh score.

The five factors, point by point

Five factors each give 1, 2 or 3 points:

• Total bilirubin (umol/L): under 34 is 1 point, 34 to 50 is 2 points, above 50 is 3 points.
• Serum albumin (g/L): above 35 is 1 point, 28 to 35 is 2 points, under 28 is 3 points.
• PT INR: under 1.7 is 1 point, 1.71 to 2.30 is 2 points, above 2.30 is 3 points.
• Ascites: none is 1 point, mild is 2 points, moderate to severe is 3 points.
• Hepatic encephalopathy: none is 1 point, grade I-II or encephalopathy suppressed with medication is 2 points, grade III to IV or refractory encephalopathy is 3 points.