Child Pugh Classification for Severity of Liver Disease

 
Encephalopathy

None (1 point)

 Grade 1: Altered mood/confusion (2 points)

 Grade 2: Inappropriate behavior, impending stupor, somnolence (2 points)

 Grade 3: Markedly confused, stuporous but arousable (3 points)

 Grade 4: Comatose/unresponsive (3 points)
Ascites

Absent (1 point)

 Slight (2 points)

 Moderate (3 points)
Bilirubin

<2 mg/dL (1 point)

 2-3 mg/dL (2 points)

 >3 mg/dL (3 points)
Albumin

>3.5 g/dL (1 point)

 2.8-3.5 g/dL (2 points)

 <2.8 g/dL (3 points)
Prothrombin time prolongation

Less than 4 seconds above control/INR <1.7 (1 point)

 4-6 seconds above control/INR 1.7-2.3 (2 points)

 More than 6 seconds above control/INR >2.3 (3 points)

 
Total Criteria Point Count:
 

 

 CTP Score Interpretation

 
5 to 6 points: Child class A
7 to 9 points: Child class B
10 to 15 points: Child class C

 
Notes
  • In cases of Primary Biliary Cirrhosis, Bilirubin point values are sometimes considered differently:
     
    • 1-4 mg/dL -->1 point
    • 4-10 mg/dL -->2 points
    • >10 mg/dL -->3 points

 
References
  1. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:646. PubMed ID: 4541913 PubMed Logo
  2. Child CG, Turcotte JG. The Liver and Portal Hypertension. Philadelphia, WB Saunders Co. 1964. NLMN ID: 46218 NCBI Logo
  3. Trey C, Burns DG, Saunders SJ. Treatment of hepatic coma by exchange blood transfusion. NEJM. 1966; 274:473. PubMed ID: 5904286 PubMed Logo

 

 
 
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