Child-Pugh Score

Formula

Sum of 5 items (1-3 each): bilirubin <2 / 2-3 / >3 mg/dL; albumin >3.5 / 2.8-3.5 / <2.8 g/dL; INR <1.7 / 1.7-2.3 / >2.3; ascites; encephalopathy. Class A 5-6, B 7-9, C 10-15.

Limitations

• Pugh 1973 used prothrombin time prolongation (under 4 s, 4-6 s, over 6 s); the INR thresholds (1.7 and 2.3) are a later adaptation. The middle band includes its limits (bilirubin 2-3 mg/dL, albumin 2.8-3.5 g/dL, INR 1.7-2.3).
• Grading of ascites and encephalopathy is subjective.

References

1. Transection of the oesophagus for bleeding oesophageal varices. Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Br J Surg. 1973;60(8):646-649. PMID 4541913
2. Surgery and portal hypertension. Child CG, Turcotte JG. In: Child CG, ed. The Liver and Portal Hypertension. Philadelphia: Saunders; 1964:50-64.