Gastroenterology Education and CPD for trainees and specialists » Child-Turcotte-Pugh (CTP) Classification of Severity of Liver Disease

Child Pugh score is used to assess prognosis/mortality in absence of liver transplantation in a cirrhotic patient and hence plan the timing for liver transplantation.

Dr C.G. Child and Dr J.G. Turcotte of the University of Michigan first proposed the scoring system in 1964. It was modified by Pugh et al in 1972 when Child's criterion of nutritional status was replaced with the prothrombin time or INR, and thus eliminated the most subjective part of the score.

Grades of Hepatic Encephalopathy

Grade 1 - Inverted sleep pattern; forgetfulness, agitation, irritability, apraxia
Grade 2 - Lethargy; Disorientation for time or place, Subtle personality change; Asterixis, ataxia
Grade 3 - Somnolence but rousability, Disorientation as regards place; Asterixis, hyperactive reflexes, Babinski signs, muscle rigidity
Grade 4 - Coma (unresponsive to verbal or noxious stimuli)

The correlation of grades and mortality :

Child -Pugh Grade	Points	One-year patient survival (%)	Two-year patient survival (%)
A: well-compensated disease	5 - 6	100	85
B: functional compromise- worsening disease	7 - 9	80	60
C: Decompensated disease	10 - 15	45	35

Reference:

Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). "Transection of the oesophagus for bleeding oesophageal varices". The British journal of surgery 60 (8): 646–9.

Disclaimer:
The calculators allow you to enter patient specific information to calculate a simple score. All information is provided for educational purposes only. This information is not intended to replace clinical judgement. All calculations must be rechecked and should not be used alone to guide patient care. The user assumes sole responsibility for any decisions or action taken based on the information contained here.

Bilirrubin	<34 µmol/L +1 34-50 µmol/L +2 >50 µmol/L +3 <2 mg/dL +1 2-3 mg/dL +2 >3 mg/dL +3
Albumin	>35 g/L +1 28-35 g/L +2 <28 g/L +3 >3.5 g/dL +1 2.8-3.5 g/dL +2 <2.8 g/dL +3
Prothrombin time	<1.8 (INR) or <4 secs (Seconds over control) +1 1.8-2.2 (INR) or 4-6 secs (Seconds over control) +2 >2.2 (INR) or >6 secs (Seconds over control) +3
Ascites	Absent +1 Slight (Medically controlled ) +2 Moderate (Poorly controlled) +3
Encephalopathy	None +1 Grade 1-2 +2 Grade 3-4 +3
Score	points

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Child-Turcotte-Pugh (CTP) Classification of Severity of Liver Disease

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