Question

A patient’s Child–Pugh score needs to be calculated. The lab values and clinical findings are:
Total bilirubin: 2.6 mg/dL
Ascites: mild
Serum albumin: 2.9 g/dL
Hepatic encephalopathy: markedly lethargic and drowsy (severe)
Prothrombin time: 36 sec, with control = 12 sec
What is the total Child–Pugh score?

• A. 12
• B. 13
• C. 11
• D. 10

Hint:

Child-Pugh Classes:
- Class A: 5 to 6 points (Good operative risk).
- Class B: 7 to 9 points (Moderate risk).
- Class C: 10 to 15 points (High operative risk, mortality highly probable).

Answer 1

The Correct Option is A

Concept:
The Child-Pugh score is utilized to assess the prognosis of chronic liver disease, primarily cirrhosis, by scoring five clinical and laboratory parameters on a scale of 1 to 3.
Explanation:
• Bilirubin (mg/dL): $<2$ (1 point), 2–3 (2 points), $>3$ (3 points).
Here, Bilirubin is 2.6 mg/dL $\rightarrow$ 2 points.

• Albumin (g/dL): $>3.5$ (1 point), 2.8–3.5 (2 points), $<2.8$ (3 points).
Here, Albumin is 2.9 g/dL $\rightarrow$ 2 points.

• Prothrombin Time (PT) prolongation over control (seconds): $<4$ (1 point), 4–6 (2 points), $>6$ (3 points).
Here, PT is 36 sec with a control of 12 sec. Prolongation = 36 - 12 = 24 seconds. Since 24 $>$ 6 $\rightarrow$ 3 points.

• Ascites: None (1 point), Mild/Moderate (controlled with medication) (2 points), Severe/Refractory (3 points).
Here, Ascites is mild $\rightarrow$ 2 points.

• Encephalopathy: None (1 point), Grade I-II (mild/moderate) (2 points), Grade III-IV (severe, stupor/coma) (3 points).
Here, the patient is markedly lethargic (severe) $\rightarrow$ 3 points.

• Total Score Calculation: 2 (Bilirubin) + 2 (Albumin) + 3 (PT) + 2 (Ascites) + 3 (Encephalopathy) = 12.
Final Answer:
By summing the points across the five criteria, the patient's total Child-Pugh score is calculated to be 12, placing them in Child-Pugh Class C (severe disease).