The Child-Pugh score is used to assess hepatic functional reserve before hepatic resection. A patient with hepatic cirrhosis has bilirubin 2.8 mg/dL, albumin 2.7 g/dL, PT prolongation of 6 seconds, grade II encephalopathy, and moderate ascites. Computing the score: bilirubin 2.8 = 2 pts, albumin 2.7 = 3 pts, PT +6 sec = 3 pts, encephalopathy grade 2 = 2 pts, moderate ascites = 2 pts — total = 12 points. What is the Child-Pugh class and operability?

• A Child-Pugh B (7–9 pts); minor hepatectomy acceptable
• B Child-Pugh C (10–15 pts); hepatic resection is contraindicated, transplant evaluation warranted ✓
• C Child-Pugh A (5–6 pts); major hepatectomy is safe
• D Child-Pugh B (7–9 pts); major hepatectomy acceptable with portal vein embolisation

Explanation

Score calculation: bilirubin 2.8 mg/dL = 2 pts; albumin 2.7 g/dL = 3 pts; PT prolonged 6 sec = 3 pts; grade II encephalopathy = 2 pts; moderate ascites = 2 pts; total = 12 points. Child-Pugh C is defined as 10–15 points and carries a high operative mortality risk. Hepatic resection is contraindicated in Child-Pugh C; these patients should be assessed for liver transplantation or palliative treatments.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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