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MSDMerck ManualProfessional Version
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Child-Turcotte-Pugh Scoring System

Clinical or Laboratory Factor

Degree of Abnormality

Points Assigned*

Encephalopathy (grade†)

None

1

1–2

2

3–4

3

Ascites

None

1

Mild (or controlled by diuretics)

2

At least moderate despite diuretic treatment

3

> 3.5 g/dL (35 g/L)

1

2.8–3.5 g/dL (28–35 g/L)

2

< 2.8 g/dL (28 g/L)

3

Bilirubin

< 2 mg/dL (34 micromol/L)

1

2–3 mg/dL (34– 51 micromol/L)

2

> 3 mg/dL (51 micromol/L)

3

PT (seconds prolonged)

< 4

1

4–6

2

> 6

3

or, instead of PT

INR

< 1.7

1

1.7–2.3

2

> 2.3

3

* Risk (grade) is based on the total number of points:

  • Low (A): 5–6

  • Moderate (B): 7–9

  • High (C): 10–15

† Encephalopathy is graded based on symptoms:

  1. 1: Sleep disturbances; impaired concentration; depression, anxiety, or irritability

  2. 2: Drowsiness, disorientation, poor short-term memory, uninhibited behavior

  3. 3: Somnolence; confusion; amnesia; anger, paranoia, or other bizarre behavior

  4. 4: Coma

INR = international normalized ratio; PT = prothrombin time.

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