Child Pugh Score

Used to assess the prognosis of chronic liver disease, mainly cirrhosis

Measures
1 point
Total
billirubin
umol/l <34 (<2)
(mg/dl)
Serum albumin (g/dl)
>3.5
PT INR
<1.7
Ascites
Hepatic encelopathy
-

Points
5-6
7-9
10-15

Class
A
B
C

2 point
34-50 (2-3)
2.8-3.5
1.71-2.30
Mild
I-II (supressed
medication)

3 point
>50 (>3)
<2.8
>2.30
Moderate to severe
with III-IV (refractory)

1 Year Survival
100%
81%
45%

2 Year Survival
85%
57%
35%

Metavir Score
Used to interpret liver biopsy results
Fibrosis score :

Activity (inflammation-necroinflammation) :

F0 : No Fibrosis

A0 : No Activity

F1 : Portal Fibrosis Without Septa

A1 : Mild Activity

F2 : Portal Fibrosis With Septa

A2 : Moderate Activity

F3 : Numerous Septa without Cirrhosis

A3 : Severe Activity

F4 : Cirrhosis

Ishak Score
Used assess liver biopsy in chronic viral hepatitis
Periportal or Periseptal Interface Hepatitis (Piecemeal Necrosis)
Absent
Mild (focal, few portal areas)
Mild/Moderate (focal, most portal areas)
Moderate ( Continous araound <50% of tracts or septa)
Severe ( Continous around >50% of tracts or septa)
Confluent Necrosis
Absent
Focal Confluent Necrosis
Zone 3 necrosis in some areas
Zone 3 necrosis in most areas
Zone 3 necrosis + occasional portal-central (P-C) bridging
Zone 3 necrosis + multiple portal-central (P-C) bridging
Panacinar or multiacinar necrosis
Focal (spotty) lytic necrosis,
inflammation
Absent
One focus or less per x 10 objective
Two to four foci per x 10 objective
Five to ten foci per x 10 objective
More than 10 foci per x 10 objective
Portal Inflammation
Absent
Mild, some or all portal areas
Moderate, some or all portal areas
Moderate/marked, all portal areas
Marked, all portal areas

apoptosis,

and

Points
0
1
2
3
4

Points
0
1
2
3
4
5
6
focal Points
0
1
2
3
4

Points
0
1
2
3
4

FibroScan (Transient Elastography)

Used to evaluate liver fibrosis, in cirrhotic the value is about 12.5-75.5 kPa