Kumar et al modified the Child-Turcotte-Pugh score by adding variceal status. This can be used to predict mortality in patients with cirrhosis. The authors are from Sir Ganga Ram Hospital and the Institute of Liver & Biliary Sciences in India.
Patient selection: patient with cirrhosis
Parameters:
(1) Child-Turcotte-Pugh score (from 5 to 15)
(2) variceal status
History of Variceal Bleeding
Size of Varices
Points
yes
NA
3
no
medium or large
2
no
none or small
1
where:
• Small esophageal varices are minimally elevated, straight or slightly tortuous, < 3 mm, without red-color signs.
• Medium esophageal varices are 3 to 6 mm.
• Large esophageal varices are enlarged, nodular and > 6 mm in diameter.
total score =
= (CTP score) + (variceal status)
Interpretation:
• minimum score: 6
• maximum score: 18
• The higher the score the worse the survival.
Total Score
1-Year Mortality (Fan)
6 to 9
3%
10 or 11
11%
12 to 18
34%
Performance:
• In the study of Fan et al the area under the ROC curve was 0.81 for 3 month and 0.83 for 12 month enrollment. These were about the same as the CTP score without variceal status.
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