The Child-Pugh score is used to assess liver functional reserve before hepatic resection. Which parameter is NOT included in Child-Pugh scoring?

• A Serum bilirubin
• B Prothrombin time (INR)
• C Serum albumin
• D Serum alkaline phosphatase ✓

Explanation

Child-Pugh score uses 5 parameters: serum bilirubin, serum albumin, INR/prothrombin time, degree of ascites, and degree of hepatic encephalopathy — each scored 1–3, totalling 5–15. Class A (5–6) = well-compensated; Class B (7–9) = significant compromise; Class C (10–15) = decompensated. Alkaline phosphatase is NOT included. The MELD score uses bilirubin, creatinine, and INR and is used for organ allocation; Child-Pugh is more widely used for surgical risk assessment.

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

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