Overview

The Child–Turcotte–Pugh (CTP) score, also known as the Child–Pugh score, is a widely used clinical system for assessing the severity and prognosis of chronic liver disease, particularly liver cirrhosis.

It provides an overall picture of liver function by combining laboratory values with clinical findings, helping doctors estimate disease severity, risk of complications, and long-term outlook.

The CTP score is commonly used alongside other scoring systems such as the MELD score, but each serves a distinct clinical purpose.

What Is the CTP Score Used For?

The CTP score helps clinicians to:

• Classify the severity of cirrhosis
• Estimate prognosis and survival
• Assess risk before surgeries or procedures
• Guide treatment planning and monitoring
• Support decisions regarding advanced liver care and transplant evaluation

Unlike MELD, the CTP score includes clinical judgement-based parameters, making it especially useful in day-to-day clinical practice.

Parameters Used in the CTP Score

The CTP score is calculated using five parameters, each scored from 1 to 3 points based on severity.

Laboratory Parameters

• Total Bilirubin – reflects the liver’s ability to clear bile pigments
• Serum Albumin – indicates the liver’s protein-producing capacity
• INR (International Normalized Ratio) – reflects liver-dependent blood clotting function

Clinical Parameters

• Ascites – presence of fluid accumulation in the abdomen
• Hepatic Encephalopathy – neurological effects caused by liver dysfunction

Each parameter contributes to the overall score, with higher points indicating more severe liver impairment.

Child-Pugh Scoring Table

CTP Score Classification

The total CTP score ranges from 5 to 15 points.

🟢 Child–Pugh Class A (5–6 points)

• Well-compensated liver disease
• Liver function largely preserved
• Best overall prognosis

🟡 Child–Pugh Class B (7–9 points)

• Significant liver dysfunction
• Increased risk of complications
• Intermediate prognosis

🔴 Child–Pugh Class C (10–15 points)

• Decompensated liver disease
• High risk of complications
• Poor prognosis
• Often considered for liver transplant evaluation

Example of CTP Score Calculation

A patient with the following findings:

• Total bilirubin: 3.4 mg/dL → 3 points
• Serum albumin: 2.6 g/dL → 3 points
• INR: 2.0 → 2 points
• Ascites: Mild / controlled → 2 points
• Encephalopathy: None → 1 point

Total CTP score = 11
➡️ Child–Pugh Class C

CTP Score vs MELD Score

In clinical practice, CTP and MELD scores are often used together, as they provide complementary information.

Role of CTP Score in Liver Disease Management

• Helps identify compensated vs decompensated cirrhosis
• Assists in monitoring disease progression
• Guides medication safety and procedural risk
• Supports discussions around advanced liver care
• Helps determine the need for specialist referral

Important Note for Patients

Some components of the CTP score, particularly ascites and encephalopathy, require clinical assessment by a doctor.

The CTP score should always be interpreted by a qualified liver specialist and not used for self-diagnosis or treatment decisions.

Summary

The Child-Turcotte-Pugh (CTP) score is a well-established clinical tool that helps assess the severity and prognosis of chronic liver disease. When used alongside other scoring systems such as MELD, it provides a more complete understanding of liver function and disease progression.

CTP score evaluation and interpretation are provided under the supervision of
Dr. Saurabh Singhal,
Director & Head – Centre for Liver-GI Diseases & Transplantation (CLDT),
Aakash Healthcare.

Clinical judgment by a liver specialist is essential for accurate interpretation and appropriate management.