Child-Pugh Score

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The Child-Pugh score ( Child-Pugh criteria ), also known as the Child-Turcotte-Pugh score , is used in medicine to classify cirrhosis of the liver . At the same time, these stages can be used to estimate the patient's prognosis. The Child-Pugh criteria were first published in 1964 by Charles Gardner Child (* 1908; † 1991) and Jeremiah G. Turcotte ( University of Michigan ) and modified by Pugh in 1972 (see literature). A newer score that is increasingly replacing the Child-Pugh score, especially in transplant medicine, is the MELD score or MELD-Plus; Another alternative is the ALBI grade .

Creation of the score

A total number of points is established on the basis of five criteria (three laboratory values ​​and two clinical findings), with 1-3 points being awarded in each case, so that a score of 5 to 15 can be achieved.

criteria 1 point 2 points 3 points unit
Serum bilirubin (total) <2.0
<34.2 		2.0-3.0
34.2-51.3 		> 3.0
51.3 		mg / dl (x 17.104 = µmol / l)
µmol / l
Serum albumin > 3.5 2.8-3.5 <2.8 g / dl
Quick value or

INR

> 70

<1.7

40-70

1.71-2.20

<40

> 2.20

%

-

Ascites on ultrasound none light moderate -
hepatic encephalopathy no Stage I-II Stage III – IV -

The values ​​and units can differ slightly depending on the author and publication.

If one of the cholestatic liver diseases, primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC) is present, other reference ranges for bilirubin apply :

1 point: bilirubin <4.0 mg / dl; 2 points: 4-10 mg / dl; 3 points> 10.0 mg / dl.

Stages and statements about the prognosis

Based on the number of points, the division into Child-Pugh stages A to C is made:

Points stage 1 year survival rates 2 year survival rates 3 year survival rates 5 year survival rates perioperative mortality
5-6 A. 100% 85% 70% 50% 10%
7-9 B. 81% 57% 36% 26% 30%
10-15 C. 45% 35% 17% 15% 82%

During therapy with oral anticoagulants, the Child-Pugh score can no longer be used as the sole parameter of hepatic insufficiency, since the INR rises as a result of the therapy , even with direct oral anticoagulants . This is especially important when deciding whether to use other drugs. While direct oral anticoagulants should no longer be used in stage C, therapy with warfarin is possible with frequent INR measurement, provided the risk of bleeding does not exceed the expected clinical benefit.

ALBI degree

Since the classification of the Child-Pugh stages depends on subjective factors such as the classification of ascites and encephalopathy, an alternative classification for liver functionality was presented in 2015: the ALBI grade.

It is based on the Al bumin- and Bi lirubinwerten and is output in three classes (1 to 3).

ALBI grade = (log 10 bilirubin [µmol / l] · 0.66) + (albumin [g / l] · (−0.0852))

If the result is less than or equal to −2.60, the degree is 1, between −2.60 and −1.39 degree 2 and greater than −1.39 degree 3.

Individual evidence

  1. ↑ Dr. Charles G. Child, 83, Is Dead; Surgeon and Hypertension Expert . ( nytimes.com [accessed October 13, 2018]).
  2. ^ DocCheck Medical Services GmbH: Child-Pugh criteria - DocCheck Flexikon. Retrieved October 13, 2018 .
  3. ↑ a b Pramod Kumar Mishra: Textbook of Surgical Gastroenterology, Volumes 1 & 2 . JP Medical Ltd, 2016, ISBN 978-93-5152998-9 , pp. 910 ( digitized versionhttp: //vorlage_digitalisat.test/1%3D~GB%3D0LyfCwAAQBAJ~IA%3D~MDZ%3D%0A~SZ%3DPA910~ double-sided%3D~LT%3D~PUR%3D ).
  4. ^ A b Yun-Hsuan Lee et al .: A New Child-Turcotte-Pugh Class 0 for Patients with Hepatocellular Carcinoma: Determinants, Prognostic Impact and Ability to Improve the Current Staging Systems . In: PLoS ONE . tape 9 , no. 6 , June 6, 2014, doi : 10.1371 / journal.pone.0099115 , PMID 24906132 , PMC 4048310 (free full text).
  5. ↑ P. Schweikert-Wehner: Oral anticoagulants for hepatic insufficiency . Ed .: The family doctor. No. 4 . Urban & Vogel, Munich 2019, p. 8-11 .
  6. ^ Philip J. Johnson et al .: Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach — The ALBI Grade . In: Journal of Clinical Oncology . tape 33 , no. 6 , February 20, 2015, p. 550–558 , doi : 10.1200 / JCO.2014.57.9151 , PMID 25512453 , PMC 4322258 (free full text).
  7. ↑ Bin Gui et al .: Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated With Radioembolization . In: American journal of clinical oncology . tape 41 , no. 9 , September 2018, p. 861–866 , doi : 10.1097 / COC.0000000000000384 , PMID 28418940 , PMC 5645222 (free full text).

literature

  • CG Child, JG Turcotte: Surgery and portal hypertension . In: CG Child (Ed.): The liver and portal hypertension . Saunders, Philadelphia 1964, pp. 50-64.
  • RN Pugh, IM Murray-Lyon, JL Dawson, MC Pietroni, R. Williams: Transection of the oesophagus for bleeding oesophageal varices. In: British Journal of Surgery . Volume 60, Number 8, August 1973, pp. 646-649, ISSN  0007-1323 . PMID 4541913 .
  • Guadalupe Garcia-Tsao: The Child – Turcotte Classification: From Gestalt to Sophisticated Statistics and Back . In: Digestive Diseases and Sciences . tape 61 , no. 11 , September 30, 2016, p. 3102-3104 , doi : 10.1007 / s10620-016-4319-7 , PMID 27696097 , PMC 5218597 (free full text).

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