The Child-Pugh score is a system for assessing the prognosis — including the required strength of treatment and necessity of liver transplant — of chronic liver disease, primarily cirrhosis. It provides a forecast of the increasing severity of your liver disease and your expected survival rate.
It’s also referred to as the Child-Pugh classification, the Child-Turcotte-Pugh (CTP) calculator, and the Child Criteria.
The Pugh-Child score is determined by scoring five clinical measures of liver disease. A score of 1, 2, or 3 is given to each measure, with 3 being the most severe.
The five clinical measures are:
- total bilirubin: yellow compound in bile from hemoglobin breakdown
- serum albumin: blood protein produced in the liver
- prothrombin time, prolongation(s) or INR: time for blood to clot
- ascites: fluid in peritoneal cavity
- hepatic encephalopathy: brain disorder from liver disease
- If the ascites result is “none,” that measure would be scored with 1 point.
- If the ascites result is “mild/diuretic responsive,” that measure would be scored with 2 points.
- If the ascites result is “moderate/diuretic refractory,” that measure would be scored with 3 points.
Once scores are available in each of the five clinical measures, all scores are added and the result is the Child-Pugh score.
The interpretation of the clinical measures is as follows:
- 5 to 6 points
- least severe liver disease
- one- to five-year survival rate: 95%
- 7 to 9 points
- moderately severe liver disease
- one- to five-year survival rate: 75%
- 10 to 15 points
- most severe liver disease
- one- to five-year survival rate: 50%
The Model for End-Stage Liver Disease, or MELD score, is used to prioritize adult patients for liver transplants. It’s a severity index that indicates mortality risk and case urgency. It determines how soon a person will need a liver transplant.
You must have a MELD score to be put on the United Network for Organ Sharing (UNOS) transplant list
The MELD score is calculated with a mathematical formula using three lab results:
The 4 MELD levels are
- greater than or equal to 25 (gravely ill)
- 24 to 19
- 18 to 11
- less than or equal to 10 (less ill)
Patients with end-stage liver disease are tested on a continuing basis:
- greater than or equal to 25: lab reports every 7 days
- 24 to 19: lab reports every 30 days
- 18 to 11: lab reports every 90 days
- 10 or fewer (less ill): lab reports every year
As the MELD score increases, the patient moves up the transplant list.
The PELD score (Pediatric End-stage Liver Disease) is a version of the MELD score for children under the age of 12. Like the MELD score, it’s used to prioritize patients for liver transplant.
Part of the diagnosis and treatment portion of liver disease is a Child-Pugh score for the prognosis of liver failure. It serves as a marker for liver function and helps determine appropriate treatment.
In end-stage liver disease, liver functions decline to a point where the only option becomes liver transplantation. To get on the UNOS transplantation list, you need a MELD score — or PELD score if you’re under age 12.