• Shaikh Samiullah
  • Rahoopoto Qasim
  • Shaikh Khalid
  • Baloch Ghulam Hussain
  • Jaffery Mukhtair
  • Yousfani Akbar


Background: Original Child-Turcotte-Pugh (CTP) score has traditionally being used as a usefultool to assess prognosis in cirrhotic patients but the serum creatinine level has recently seen as animportant predictor of survival in patients with liver cirrhosis. The aim of this study was tocompare the accuracy of CP and modified CP score for predicting in hospital survival as well ascirrhosis related complications such as encephalopathy, haematemesis and ascites in patients withdecompensated cirrhosis. It was Descriptive case series. The study was conducted at Departmentof Medicine, Liaquat University of Medical & Health Sciences Jamshoro from October 2005 toJuly 2007. Methods: This study included 222 patients with decompensated cirrhosis diagnosedeither clinically or radio-logically were followed-up during hospital stay. Patient’s demographicdata was enrolled in well designed proforma which included enquiry regarding cirrhosis relatedcomplications. Patients were classified according to original CP classification into A, B and C andmodified Child Pugh scores estimated by adding 0, 2 and 4 points with serum creatinine <1.3mg/dL,1.3–1.8 and >1.8 mg/dl respectively to the original score using creatinine levels as a sixthcategorical variable were evaluated. Simple t-test and Chi-square test were done for continuousand categorical data. Original CP and creatinine modified CP was compared by the ROC curve.p<0.05 was considered significant. Results: In this study 222 cirrhotic patients constituting 144 (65%male and 78 (35%) female. The mean age of the patients were 46.8±12.8 and mean serum creatinine1.41±0.55 mg/dl. In Original Child-pugh classification 9, 82, 131 out of 222 were in grade A, B and Crespectively whereas in creatinine-modified child-pugh classification 7, 28 and 187 patients were ingrade A, B and C respectively. For cirrhosis related complications creatinine modified child Pugh has abetter predictive value for encephalopathy (p=0.03) as compared to original child Pugh (p=0.42)whereas for haematemesis (p=0.001) and grades of ascites (p=0.003) creatinine modified CP wasmarginally better than original CP (p=0.004) and (p=0.007) respectively. Predicting the in hospitaldeath and duration of hospitalization as outcome creatinine modified CP (p=0.001) as compared tooriginal CP (p=0.004). ROC (receiver–operating characteristic) curve the creatinine-modified CTPscore showed a marginal, better prognostic accuracy as compared with the CTP score (CTP vscreatinine-modified CTP, c-index and 95% CI=0.654 (0.578–0.731), vs 0.642 (0.562–0.722), p=0.001).Conclusion: Inclusion of serum creatinine can improve the prognostic value of Child-Pughclassification particularly class B in which the serum creatinine play a major role in properly predictedthe survival as well as cirrhosis related complications.Keywords: child-pugh, cirrhosis of liver, serum creatinine, encephalopathy.


D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival

and prognostic indicators in compensated and decompensated

cirrhosis. Dig Dis Sci 1986;31:468–75.

Forman LM, Lucey MR. Predicting the prognosis of chronic

liver disease: an evolution from Child to MELD. Hepatolog


Child C, Turcotte J. The liver and portal hypertension. In:

Child CI, ed. Surgery and Portal Hypertension. Philadelphia,

USA: WB Saunders;964. p.50–8.

Pugh R, Murray-lyon I, Dawson J. Transection of the

oesophagus for bleeding oesophageal varices. Br J Surg


Gines A, Escorsell A, Gines P, Salo J, Jimenez W, Inglada L,

et al. Incidence, predictive factors, and prognosis of the

hepatorenal syndrome in cirrhosis with ascites.

Gastroenterology 1993;105:229–36.

Nair S, Verma S, Thuluvath PJ. Pretransplant renal function

predicts survival in patients undergoing orthotopic liver

transplantation. Hepatology 2002;35:1179–85.

Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig

F, Pidlich J, et al. Child–Pughversus MELD score in

predicting survival in patients undergoing transjugular

intrahepatic portosystemic shunt. Gut 2003;52:879–85.

Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P, Uriz

J, Quintó L, Ventura PJ, et al. A prognostic model for

predicting survival in cirrhosis with ascites. J Hepatol


Sanyal A J, Genning C, Rajender Reddy K, Wong

F, Kowdley KV, Benner K, et al. The North American study

for the treatment of refractory ascites. Gastroenterology


Salerno F, Borroni G, Moser P, Badalamenti S, Cassara L,

Maggi A, Fusini M, et al. Survival and prognostic factors of

cirrhotic patients with ascites: a study of 134 outpatients. Am

J Gastroenterol 1993;88:514–9.

Schepis F, Camma C, Niceforo D, Magnano A, Pallio S,

Cinquegrani M. et al. Which patients with cirrhosis should

undergo endoscopic screening for esophageal varices

detection? Hepatology 2001;33:333–8.c