Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

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

The Mumtaz readmission risk score for decompensated cirrhosis predicts the likelihood of a patient being readmitted to the hospital within 30 days after discharge. It does this by evaluating various factors related to the patient's demographics, clinical condition, and hospital experience, assigning each a score, and summing these to create an overall risk score. Here’s how the risk score is computed:

The assessment considers the following factors:

- **Age, Years:**
  - 18-39: 7 points
  - 40-64: 4 points
  - ≥ 65: 0 points

- **Primary Payer:**
  - Medicare: 4 points
  - Medicaid: 5 points
  - Private insurance: 0 points
  - Self-pay: 3 points
  - No charge or other: 1 point

- **Elixhauser Comorbidity Index:**
  - ≥ 3: 2 points
  - < 3: 0 points

- **Non-Alcoholic Etiology of Cirrhosis:**
  - Yes: 2 points
  - No: 0 points

- **Ascites:**
  - Yes: 5 points
  - No: 0 points

- **Hepatic Encephalopathy:**
  - Yes: 4 points
  - No: 0 points

- **Variceal Bleeding:**
  - Yes: 7 points
  - No: 0 points

- **Hepatocellular Carcinoma:**
  - Yes: 3 points
  - No: 0 points

- **Paracentesis During Admission:**
  - Yes: 4 points
  - No: 0 points

- **Hemodialysis During Admission:**
  - Yes: 7 points
  - No: 0 points

- **Disposition:**
  - Routine: 0 points
  - Transfer: 1 point
  - Home health care: 1 point
  - Against medical advice: 10 points

To calculate the total score, sum the points corresponding to the selected option within each category. This score ranges from 0 to 56 and correlates to specific readmission risk probabilities. 

The interpretation of the score is as follows:
- Score up to -11: 10-15% risk of 30-day readmission
- Score from -10 to 6: 16-20% risk
- Score from 7 to 12: 21-25% risk
- Score from 13 to 17: 26-30% risk
- Score from 18 to 22: 31-35% risk
- Score from 23 to 26: 36-40% risk
- Score from 27 to 30: 41-45% risk
- Score from 31 to 44: 46-61% risk
- Score of 45 and above: 62-67% risk

The score provides a straightforward method to estimate the chance of readmission, assisting medical professionals in identifying high-risk patients and tailoring post-discharge plans accordingly.

The Mumtaz Readmission Risk Score in Decompensated Cirrhosis is a clinical calculator designed to predict the risk of hospital readmission in patients with decompensated cirrhosis. This scoring system is particularly useful in the management of patients with decompensated cirrhosis, as it helps clinicians identify those at high risk of readmission, thereby allowing for targeted interventions to reduce this risk. The score is calculated based on several factors including age, serum sodium, serum creatinine, and the presence of ascites or hepatic encephalopathy. It does not apply to patients with compensated cirrhosis or those without a history of hospital admission for decompensated cirrhosis.

Mumtaz readmission risk score in decompensated cirrhosis

Portal hypertension

Management of ascites

Management of ascites, TIPS

Management of variceal hemorrhage

Management of variceal hemorrhage, blood product transfusion

Surveillance for gastroesophageal varices

Management of spontaneous bacterial peritonitis

Management of SBP, IV albumin

Management of SBP, antibiotic therapy

Diagnostic criteria

Diagnostic criteria (spleen elastography)

Evaluation of ascites

Evaluation of ascites, diagnostic paracentesis

Management of hepatorenal syndrome

Management of hepatorenal syndrome, pharmacotherapy

Diagnostic criteria, HPVG

Evaluation of variceal hemorrhage

Management of variceal hemorrhage, management of gastric hemorrhage

Evaluation of portopulmonary hypertension

Primary prevention of variceal hemorrhage

Management of variceal hemorrhage, TIPS

Management of ascites, implantable peritoneal pump

Management of portopulmonary hypertension

HVPG measurement

HVPG measurement (considerations in various etiologies)

Diagnostic criteria, liver elastography

Management of variceal hemorrhage, endoscopic variceal ligation

Pregnant patients

Prevention of spontaneous bacterial peritonitis

Prevention of SBP, secondary prevention

Management of ascites, diuretics

Management of hepatorenal syndrome (therapeutic paracentesis)

Prevention of SBP, primary prevention

Management of variceal hemorrhage (management of anorectal hemorrhage)

Evaluation of ascites (initial evaluation)

Prognosis

Management of variceal hemorrhage (balloon-occluded retrograde transvenous obliteration)

Portal hypertension

Guidelines

Key sources