Question 1

What is the Child-Pugh score and what is it used for?

Accepted Answer

The Child-Pugh score (originally Child-Turcotte-Pugh) is a clinical scoring system used to assess the severity and prognosis of chronic liver disease, primarily cirrhosis. It evaluates five parameters — total bilirubin, serum albumin, INR (or prothrombin time), degree of ascites, and grade of hepatic encephalopathy — each scored 1–3 points. It is used for cirrhosis staging, predicting surgical risk, and in transplant evaluation, though MELD has largely replaced it for transplant prioritization.

Question 2

What is the difference between Child-Pugh Class A, B, and C?

Accepted Answer

Class A (score 5–6): Well-compensated cirrhosis. 1-year survival ~100%, 2-year ~85%, operative mortality ~10%. Class B (score 7–9): Significant functional impairment. 1-year survival ~80%, 2-year ~60%, operative mortality ~30%. Class C (score 10–15): Decompensated cirrhosis. 1-year survival ~45%, 2-year ~35%, operative mortality ~82%. Class C patients should generally be considered for liver transplant evaluation.

Question 3

What is the difference between Child-Pugh score and MELD score?

Accepted Answer

Child-Pugh includes both clinical parameters (ascites, hepatic encephalopathy) and laboratory values (bilirubin, albumin, INR), making it somewhat subjective. MELD (Model for End-Stage Liver Disease) is entirely laboratory-based (serum creatinine, bilirubin, INR, sodium) and is currently used by UNOS to prioritize patients for liver transplantation because it is more objective and better predicts 90-day mortality. Child-Pugh remains useful for assessing surgical risk and general staging.

Question 4

Is there a different Child-Pugh bilirubin cut-off for PBC and PSC?

Accepted Answer

Yes. In Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC), the bilirubin thresholds are modified: 1 point for bilirubin <4 mg/dL, 2 points for 4–10 mg/dL, and 3 points for >10 mg/dL. This is because bilirubin is disproportionately elevated in cholestatic liver diseases, and using standard thresholds would unfairly inflate the score. Our calculator includes a PBC/PSC toggle for this purpose.

Question 5

What are the West Haven criteria for hepatic encephalopathy grading?

Accepted Answer

The West Haven criteria grade hepatic encephalopathy as: Grade 0 — no symptoms; Grade 1 — mild confusion, euphoria or depression, slowed thinking, impaired arithmetic; Grade 2 — lethargy, moderate confusion, personality change, inappropriate behaviour; Grade 3 — somnolent but arousable, severe confusion, gross disorientation; Grade 4 — coma (unresponsive to painful stimuli). For Child-Pugh scoring: Grade 0 = 1 point, Grade 1–2 = 2 points, Grade 3–4 = 3 points.

Question 6

What Child-Pugh score is required for liver transplant?

Accepted Answer

Child-Pugh Class C (score ≥10) generally indicates decompensated cirrhosis and should prompt transplant evaluation. However, MELD score (≥15) is the primary criterion used by transplant centres for waitlist prioritization. Child-Pugh Class B with complications (refractory ascites, variceal bleeding, SBP, hepatorenal syndrome) also warrants transplant referral regardless of exact score.

Question 7

Can the Child-Pugh score be used to predict operative mortality?

Accepted Answer

Yes. The Child-Pugh score is the most widely used tool for predicting surgical risk in cirrhotic patients. Approximate operative mortality: Class A ~10%, Class B ~30%, Class C ~82%. Elective surgery is generally contraindicated in Class C. Emergency surgery carries significantly higher mortality. MELD score >14 also predicts increased 30-day surgical mortality and should be assessed alongside Child-Pugh.

Question 8

How accurate is the Child-Pugh score?

Accepted Answer

The Child-Pugh score has limitations: the assessment of ascites and encephalopathy is subjective and observer-dependent; albumin can be affected by non-hepatic conditions (malnutrition, nephrotic syndrome); and INR can be affected by anticoagulation therapy. Despite these limitations, it remains a validated, widely-used clinical tool and correlates well with hepatic reserve and short-term survival in cirrhosis.

Question 9

What is the minimum and maximum Child-Pugh score?

Accepted Answer

The minimum Child-Pugh score is 5 (all five parameters scoring 1 point each) corresponding to Class A, and the maximum is 15 (all parameters scoring 3 points each) corresponding to Class C. A score of exactly 5 with no ascites or encephalopathy suggests good hepatic reserve.

Question 10

When was the Child-Pugh score developed?

Accepted Answer

The original Child-Turcotte score was published in 1964 by C.G. Child and J.G. Turcotte to predict survival after portocaval shunt surgery. It was modified by R.N. Pugh in 1973 who replaced the nutritional status criterion with the prothrombin time (INR), creating the current Child-Pugh (Child-Turcotte-Pugh) classification.