Emerson et al modified the Child-Turcotte-Pugh score for patients with cirrhosis in the intensive care unit (ICU). The authors are from the University of Glasgow and the Royal Infirmary Glasgow.
Patient selection: patient with cirrhosis in the ICU
Parameters for basic Child-Turcotte-Pugh score:
(1) serum total bilirubin
(2) serum albumin
(3) INR
(4) ascites
(5) hepatic encephalopathy
|
Parameter |
Finding |
Points |
|
serum total bilirubin |
< 34 µmol/L |
1 |
|
|
34-50 µmol/L |
2 |
|
|
> 50 µmol/L |
3 |
|
serum albumin |
> 35 g/L |
1 |
|
|
28-35 g/L |
2 |
|
|
< 28 g/L |
3 |
|
INR |
< 1.7 |
1 |
|
|
1.7-2.3 |
2 |
|
|
> 2.3 |
3 |
|
ascites |
none |
1 |
|
|
mild |
2 |
|
|
severe |
3 |
|
hepatic encephalopathy |
none |
1 |
|
|
Grade I or II |
2 |
|
|
Grade III or IV |
3 |
The CTP-L score adds additional points for lactate
|
Parameter |
Finding |
Points |
|
admission serum lactate |
<= 2.00 mmol/L |
1 |
|
|
2.01 to 4.0 mmol/L |
2 |
|
|
>= 4.01 mmol/L |
3 |
CTP-L =
= SUM(points for CTP score) + (points for admission serum lactate)
The CTP+L score adds the actual serum lactate value in mmol/L to the CTP score.
CTP+L =
= SUM(points for CTP score) + (serum lactate in mmol/L)
Interpretation:
• minimum CTP score: 5
• maximum CTP score: 15
• minimum CTP-L score: 6
• maximum CTP-L score: 18
• minimum CTP+L score: 5
• maximum CTP+L score: 15 plus maximum serum lactate value
• A CTP-L >= 11.5 was associated with ICU mortality.
• A CTP+L >= 14 was associated with ICU mortality.
Performance:
• The AUC for the CTP-L score was 0.78. The sensitivity was 72% and specificity 68%.
• The AUC for the CTP+L score was 0.86. The sensitivity was 79% and specificity 90%.
Purpose: To evaluate a patient with cirrhosis in the ICU using the CTP-L and CTP+L scores of Emerson et al.
Specialty: Critical Care, Emergency Medicine, Gastroenterology
Objective: severity, prognosis, stage
ICD-10: K74,
