Child-Pugh Classification for Cirrhosis (Child-Pugh)

The assessment of "Mild" vs. "Moderate" ascites is subjective. Use ultrasound to confirm if the clinical exam is indeterminate. Diuretic therapy can "improve" the score without changing the underlying liver function.

Exogenous albumin administration (e.g., after paracentesis) can temporarily raise the serum albumin level, potentially leading to an underestimate of the patient's true synthetic failure.

Class C patients are generally considered too high-risk for elective non-transplant surgery. Class A patients usually tolerate surgery well with a perioperative mortality < 10%.

If a patient moves from Class A to Class B/C, perform a diagnostic paracentesis and screen for portal vein thrombosis (PVT).

First proposed by surgeons C.G. Child and J.G. Turcotte to predict mortality in patients undergoing portosystemic shunt surgery for bleeding varices.

Richard Pugh and colleagues at King's College Hospital, London, refined the score in 1973 by making the variables more objective. This "Modified Child-Pugh" score has remained a cornerstone of hepatology for over 50 years.