How to Determine the Stages of Cirrhosis
Cirrhosis is the replacement of liver tissue by fibrous scar tissue as the result of chronic liver disease. This leads to a progressive loss of liver function which may be staged with the Child-Pugh score. This staging methodology is primarily used to determine the prognosis and required treatment for cirrhosis. The Child-Pugh score uses the results of a variety of tests to assign an aggregate score to cirrhosis cases.
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Things You'll Need
- Bilirubin level
- Serum albumin level
- International normalized ratio level
- Ascites exam
- Hepatic encephalopathy exam
Instructions
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Obtain the bilirubin score. Bilirubin is excreted by the liver and provides a general indication of liver function, with higher values indicating reduced function. Assign 1 point for a bilirubin level of less than 34 mg of bilirubin per deciliter (mg/dl) of blood, 2 points for a bilirubin level of 34 to 50 mg/dl and 3 points for a bilirubin level greater than 50 mg/dl.
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Get the serum albumin level. This value is also a common blood test and indicates the degree of distribution of various fluids throughout the body. Add 1 point for a serum albumin level of greater than 35 grams per liter (g/l), 2 points for a level of 28 to 35 g/l and 3 points for a serum albumin level less than 28 g/l.
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Calculate the international normalized ratio (INR). The INR measures the blood's clotting time and is a ratio of two values, meaning that it has no units of measure. Add 1 point for an INR less than 1.7, 2 points for an INR of 1.71 to 2.2 and 3 points for an INR greater than 2.2.
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Assess the accumulation of fluid in the peritoneal cavity, also known as ascites. No ascites adds 1 point to the Child-Pugh score, mild ascites adds 2 points and severe ascites adds 3 points.
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Evaluate the presence of hepatic encephalopathy. This condition is a neurological impairment due to toxic substances in the blood caused by poor liver function. Add 1 point to the Child-Pugh score for mild hepatic encephalopathy and 2 points and 2 points for severe hepatic encephalopathy.
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Use the total points of the Child-Pugh score to assess the severity of cirrhosis. A score of 5 to 6 points is class A liver disease which has an 85 percent chance of surviving the next two years. A score of 7 to 9 points indicates class B liver disease which has an 81 percent chance of surviving the next year and a 57 percent chance of surviving two years. A Child-Pugh score of more than 9 points indicates class C liver disease which has a 45 percent chance of surviving the next year and a 35 percent chance of surviving the next two years.
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