What are the Child-Pugh class criteria and their survival implications?

Child-Pugh scores each of five parameters on a 1–3 scale: bilirubin, albumin, INR, ascites, and hepatic encephalopathy. Total score: Class A (5–6) = compensated cirrhosis, 1-year survival ~100%, peri-operative mortality 10%; Class B (7–9) = significant dysfunction, 1-year survival ~80%, peri-operative mortality 30%; Class C (10–15) = decompensated cirrhosis, 1-year survival ~45%, peri-operative mortality >75%. Class B–C is a contraindication to most major abdominal surgery.

When is Child-Pugh preferred over MELD for prognostic assessment?

Child-Pugh is preferred for short-term surgical risk assessment due to its established peri-operative mortality correlations. MELD is the preferred tool for transplant organ allocation (used by UNOS/OPTN) and 90-day mortality prediction, as it is objective (no subjective ascites/encephalopathy grading), continuously variable, and better calibrated for waitlist mortality. In clinical practice, both scores are typically calculated together as they provide complementary information about liver reserve and disease trajectory.

Child-Pugh Cirrhosis Score

Classify cirrhosis severity using the Child-Pugh score (A/B/C) based on bilirubin, albumin, PT/INR, ascites, and hepatic encephalopathy to estimate surgical risk and 1-year survival.

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Frequently Asked Questions

What are the Child-Pugh class criteria and their survival implications?

When is Child-Pugh preferred over MELD for prognostic assessment?