Question 1

Should I use the Pugh modification (INR) or the original PT prolongation?

Accepted Answer

The Pugh modification (Child-Pugh) uses either PT prolongation or INR. Most contemporary guidelines and scoring systems use INR because it is standardised across laboratories. Use whichever is used by your local protocol or the specific staging system you are applying (e.g., BCLC for HCC).

Question 2

What if ascites or encephalopathy change with treatment?

Accepted Answer

The score is a snapshot of the patient's current status. If ascites and encephalopathy resolve or improve with therapy (e.g., diuretics, lactulose), the score should be recalculated. This may change the class and affect management, including transplant listing priority.

Question 3

Does Child-Pugh apply to patients on beta-blockers for variceal prophylaxis?

Accepted Answer

Beta-blockers do not directly affect the Child-Pugh variables. However, they may mask tachycardia as a sign of sepsis or decompensation. The score itself remains valid, but clinical assessment for encephalopathy and ascites should not rely solely on physical signs that may be modulated by concurrent medications.

Question 4

Can I use Child-Pugh in acute liver failure?

Accepted Answer

No — Child-Pugh was designed for chronic liver disease and cirrhosis. In acute liver failure, use disease-specific prognostic scores such as the King's College Criteria (for paracetamol and non-paracetamol aetiologies) or the Clichy criteria.