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Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Child-Pugh score is a clinical tool used to assess the severity of liver cirrhosis and predict perioperative mortality risk by evaluating five key parameters. These parameters are total bilirubin, albumin level, international normalized ratio (INR), presence of ascites, and degree of hepatic encephalopathy. Each parameter is assigned a score of 1 to 3, with higher scores indicating greater severity.

Here's how the scoring works:

- **Total bilirubin**:
  - Less than 2 mg/dL (34.2 mcmol/L) = 1 point
  - Between 2 and 3 mg/dL (34.2-51.3 mcmol/L) = 2 points
  - Greater than 3 mg/dL (51.3 mcmol/L) = 3 points

- **Albumin**:
  - Greater than 3.5 g/dL (35 g/L) = 1 point
  - Between 2.8 and 3.5 g/dL (28-35 g/L) = 2 points
  - Less than 2.8 g/dL (28 g/L) = 3 points

- **INR**:
  - Less than 1.7 = 1 point
  - Between 1.7 and 2.2 = 2 points
  - Greater than 2.2 = 3 points

- **Ascites**:
  - Absent = 1 point
  - Slight = 2 points
  - Moderate = 3 points

- **Encephalopathy**:
  - No encephalopathy = 1 point
  - Grade 1-2 = 2 points
  - Grade 3-4 = 3 points

The total Child-Pugh score is the sum of all points from the five categories, resulting in a score that ranges from 5 to 15. The score is then interpreted to determine the class and associated risk:

- A total score of 5 or 6 falls within Class A, where the risk of perioperative mortality is estimated to be 29%.
- Scores ranging from 7 to 9 correspond to Class B, which carries a 38% risk of perioperative mortality.
- A score of 10 or higher is categorized as Class C, indicating a high risk of perioperative mortality at 88%.

This systematic approach enables healthcare providers to evaluate the severity of liver disease and make informed medical decisions based on the patient's risk profile.

The Child-Pugh score, also known as the Child-Turcotte-Pugh score, is a clinical calculator used to assess the prognosis of chronic liver disease, primarily cirrhosis. It is specifically designed for patients with liver cirrhosis and helps to determine the severity of the disease, predict mortality, and guide treatment decisions. 

The score is calculated based on five clinical measures: total bilirubin, serum albumin, prothrombin time or INR, ascites, and hepatic encephalopathy. Each of these parameters is scored 1-3 points, and the total score classifies the patient into one of three classes (A, B, or C) with increasing severity and mortality risk.

The Child-Pugh score is not applicable to patients without liver cirrhosis or those with acute liver disease. It also may not be accurate in patients with certain co-existing conditions that can affect the scoring parameters, such as hemolysis affecting bilirubin levels or coagulopathy affecting prothrombin time.

Child-Pugh score for mortality in liver cirrhosis

Hepatitis D virus infection

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Updated 2024 WHO guidelines for the diagnosis and management of hepatitis D virus infection


Hepatitis D virus infection

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