Child-Pugh Score

The Child-Pugh score is used to classify the severity of chronic liver disease and cirrhosis to estimate prognosis and mortality. Hepatic encephalopathy is graded according to the West Haven criteria (see appendix).

Hepatic Encephalopathy (Grading)
Aszites

Child-Pugh A ( points)

1-year survival rate: 100 %

Perioperative mortality in abdominal surgery: 10 %

Child-Pugh B ( points)

1-year survival rate: 79.7 %

Perioperative mortality in abdominal surgery: 30 %

Child-Pugh C ( points)

1-year survival rate: 44.9 %

Perioperative mortality in abdominal surgery: 82 %

Interpretation
Child-Pugh A B C
1-year survival rate [4] 100 % 79.7 % 44.9 %
Perioperative mortality in abdominal surgery [5] 10 % 30 % 82 %
Appendix
West Haven criteria for the diagnosis of hepatic encephalopathy [1]
Grade I Minor loss of consciousness, euphoria or anxiety, shortened attention span, impaired calculations (addition, subtraction), altered sleep patterns
Grade II Lethargy or apathy, chronological disorientation, significant alteration in personality, inappropriate behavior, dyspraxia, asterixis
Grade III Somnolence and stupor, reaction only to stimuli, confusion, severe disorientation, bizarre behavior
Grade IV Coma
References
  1. Vilstrup H, Amodio P, Bajaj J et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60: 715-735
  2. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964; 1: 1-85
  3. Pugh RN, Murray-Lyon IM, Dawson JL et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 646-649
  4. Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology 1987; 7: 660-664
  5. Mansour A, Watson W, Shayani V et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997; 122: 730-735; discussion 735-736

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