The Child-Pugh score is a prognostic score that has been widely validated for predicting one- and two-year survival, which is 100-85%, 80-60%, and 45-35%, respectively, in patients with Child-Pugh cirrhosis A, B and C.3,4
This score also makes it possible, associated with the size and endoscopic particularities of the esophageal varices, to assess the risk of bleeding by rupture of esophageal varices. Thus, with equal endoscopic parameters, the hemorrhagic risk is higher with a Child-Pugh score C than A.5
Finally, many studies have confirmed that the Child-Pugh score is significantly correlated with per- and postoperative morbidity and mortality in cirrhotic patients.6-8 It is therefore part of the routine assessment of operative risk in this type of patient. patients.
It is important to emphasize that this score is not static, but evolves over time. It must therefore be recalculated regularly. For example, a patient suffering from Child-Pugh C cirrhosis at a given time can be classified as Child-Pugh A, six months later, if his clinical and biological condition has improved.
Although the Child-Pugh score enjoys wide popularity due to its ease of use and strength of validation in several types of liver disease, it suffers from several limitations.
Its drawbacks are primarily related to the subjective nature of the assessment of the extent of ascites and the stage of encephalopathy. In addition, the parameters will be quantified differently depending on the measurement technique (for example clinical examination or ultrasound for ascites) and the current treatment (for example diuretics for the number of ascites and lactulose for the encephalopathy). Taken together, these various factors can significantly alter the score.
On the other hand, the discriminating aspect of the Child-Pugh score is imprecise and suffers from a ceiling effect. Indeed, the bilirubin level is no longer discriminating above 50 μmol/l. Thus, patients with a bilirubin of 60 μmol/l or 150 μmol will have the same number of points, while their prognosis is clearly different. The same remark applies to serum albumin below 28 g/l. Moreover, the classification in only three stages only gives a rather rough appreciation of the degree of severity of the disease.