Child Pugh Score

Child-Pugh Score for Cirrhosis Mortality


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What Is the Child-Turcotte-Pugh Score (CTP)?

Patients of liver disease may know the Child-Turcotte-Pugh grade, which is also known as Child-Pugh score. It assesses the severity of a person's liver disease. The results show how carefully the treatment should be taken. For example, depending on the classification of your disease, you may receive medications or undergo surgery.

How you calculate the score?

The Child-Pugh score is based on five clinical hepatic disease measurements.

Bilirubin (total):

A yellow compound found in bile and blood that breaks down hemoglobin.


The main protein in the blood plasma produced by the liver.


How well your brain works with your hepatic condition.

Time of prothrombin or INR:

How long does blood take to coagulate?


It is the abdominal cavity fluid.

What do the points mean?

They are collected after the results have been calculated and your liver disease is assigned to one of three classes: A, B or C.

  • A Class: 05-06 points
    • Your condition is rated mild.
    • You may have no surgery.
  • B Class: 07-09 points
    • Your condition is rated moderate.
    • You may have surgery.
  • C Class: 10-15 points
    • Your condition is rated severe.
    • Except for a liver transplant, you probably shouldn't have surgery.

Some questions arise as to whether the Child-Pugh score is valid because some scores are subjective. For example, one doctor can measure ascites or how well your brain works differently from another. However, doctors say that it is a good tool to measure how well the liver works and how severe the liver disease is. It can also help make a treatment plan.

What is cirrhosis?

The final stage of liver scarring (fibrosis) is cirrhosis. Different forms of liver disease, such as chronic alcoholism and hepatitis, cause it. Whenever your liver gets injured, whether by illness, excessive consumption of alcohol or another cause, your liver tries to recover itself. The scar tissue forms in this process. As cirrhosis progresses, the scar tissue forms more and more, making it difficult for the liver to function. Advanced cirrhosis of the liver is a risk to life.

The liver damage caused by cirrhosis cannot generally be stopped. If cirrhosis of the liver is diagnosed early and the cause is treated, further damage can be limited and seldom reversed.

Symptoms Symptoms:

Cirrhosis often does not have any signs or symptoms until there is extensive liver damage. When signs and symptoms occur, they may contain:

Easily bruising or bleeding
Appetite loss
Itchy skin
Weight loss
Swelling in your ankles, feet or legs
Accumulation of fluid in your stomach (ascites)
Spiderlike blood vessels on your skin
Yellow discoloration in the skin and eyes (jaundice)
Redness in the palms of the hands
For women, absence or loss of non-menopausal periods
For men, sexual drive loss, testicular atrophy or breast enlargement (gynecomastia)
Drowsiness, confusion, and hepatic encephalopathy (slurred speech)
Causes Causes:

A wide variety of conditions and diseases can damage the liver and cause cirrhosis. Some of the reasons are

Abuse of chronic alcohol
Chronic Hepatitis virus (B, C, D)
Badly formed bile ducts
Deficiency of alpha-1 antitrypsin
Fat that accumulates in the liver (non-alcoholic liver illness)
Body buildup of Iron (hemochromatosis)
Accumulation of Copper in the liver
A digestive genetic disorder (Alagille)
Liver disease caused by the immune system in your body
Primary sclerosing cholangitis or bile duct hardening and scarcity
Primary biliary cirrhosis or bile duct destruction
Medicines, containing isoniazid or methotrexate
Infection, such as brucellosis or syphilis
Hereditary metabolism disorders of sugar (glycogen storage or galactosemia)

Risk Factors


Obesity increases the risk of cirrhosis-related diseases, such as liver fat and non-alcoholic steatohepatitis.


Not all chronic hepatitis develops cirrhosis, but this is one of the most common causes of hepatic disease.


Excessive consumption of alcohol is a risk for cirrhosis.


Reduce the risk of cirrhosis by following the steps to protect the liver:

Avoid Alcohol
Avoid alcohol:

If you have cirrhosis, don't drink alcohol. You should avoid drinking alcohol if you have liver disease.

Take a healthy diet
Take a healthy diet:

Choose a diet based on fruits and vegetables. Prefer protein-rich grains. Reduce the fat and fried foods you eat.

Keep a healthy weight
Keep a healthy weight:

Excess body fat can cause liver damage. Discuss a weight loss plan with your doctor if you're overweight.

Reduce hepatitis risk
Reduce hepatitis risk:

Reduce hepatitis risk:

Disclaimer: Talk to your doctor about how you can reduce the risk of liver cirrhosis if you are concerned or affected.


Portal hypertension:

High blood pressure in the veins that supply blood to the liver. Cirrhosis slows the normal blood flow through the liver and increases the blood pressure in the vein that supply blood from the intestine and spleen to the liver.

Swelling of abdomen and legs:

Increased portal pressure in the legs (edema) and stomach (ascites) may cause fluid retention. Swelling and ascites can also be caused by the fact that the liver cannot produce albumin-like blood proteins.

Enlarged spleen (splenomegaly):

Portal hypertension can also make the spleen to swell and trap white blood cells and platelets. The first sign of cirrhosis may be the reduction of white blood cells and platelets.


If you have cirrhosis, it can be difficult for your body to fight infection. Ascites can lead to serious infection with bacterial peritonitis.


It occurs when sufficient bilirubin is not removed from the blood by the ill liver. Jaundice causes the white part of eyes and the skin to yellow and the urine to become dark.


Cirrhosis can make the processing of nutrients difficult for your body, leading to weakness and weight loss.

Disease of the bone:

Cirrhosis cause in losing bone strength in some people and the risk of fractures is higher.

Increased liver cancer risk:

Most people with liver cancer already have cirrhosis of the liver.

Cirrhosis of acute-on-chronic:

CMulti-organ failure occurs in some people. The researchers believe this is a clear complication for some people who have cirrhosis. But researchers have not understood the reason yet.

Hepatic encephalopathy or toxin builds up in the brain:

The liver that is damaged by cirrhosis cannot remove toxins from the blood. This unremoved toxin can then intensify in the brain, causing difficulty in concentration and mental confusion. Liver encephalopathy may lead to a lack of reaction or coma over time.

Hemorrhagic or bleeding:

Portal hypertension can lead to blood transfer to a smaller vein. Added pressure can lead to a rupture of these small blood vessels and serious bleeding. Portal hypertension may cause verices in the stomach (gastric varicose veins) or esophagus and cause bleeding that can be life-threatening. If the liver is not able to produce enough coagulation factors, the liver can also cause continuous bleeding.

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