Child-Turcotte-Pugh (CTP) classification of the severity of cirrhosis

Points*

1 2 3

Encephalopathy None Grade 1-2 (or precipitant-induced)

Grade 3-4 (or chronic)

Ascites None Mild/Moderate (diuretic-responsive)

Severe (diuretic-refractory)

Bilirubin (mg/dL | mcmol/L) <2 | 34 2-3 | 34-50 >3 | 50

Albumin (g/dL) >3.5 2.8-3.5 <2.8

PT (sec prolonged) or INR

<4 <1.7

4-6 1.7-2.3

>6 >2.3

*CTP score is obtained by adding the score for each parameter.

Stages of hepatic encephalopathy:Stage 1: Euphoria or depression, mild confusion, slurred speed, disordered sleep;Stage 2: Lethargy, moderate cofusion;Stage 3: Marked confusion, incoherent speech, sleeping but arousable;Stage 4: Coma, initially responsive to noxious stimuli, but later unresponsive;

One year survival Two year survivalCTP class: A = 5-6 points 100% 85%

B = 7-9 points 81% 57%C = 10-15 points 45% 35%

Adopted from: Sloss A, Kubler P. Prescribing in liver disease. Aust Prescr 2009; 32:32-5.