Child-Turcotte-Pugh (CTP): PT or INR Variant
The Child-Turcotte-Pugh calculator implements the standard bilirubin table for an adult with established chronic liver disease or cirrhosis. It returns the five-component total and Class A, B, or C. It does not output a fixed survival estimate or decide transplant priority, surgery, treatment, or medication dosing.
The two coagulation variants
Choose exactly one source-defined alternative:
- INR: less than 1.7 scores 1; 1.7 through 2.3 scores 2; above 2.3 scores 3.
- PT prolongation: less than 4 seconds above laboratory control scores 1; 4 through 6 seconds scores 2; above 6 seconds scores 3.
PT prolongation means seconds above the laboratory control, not the patient's raw PT. INR and PT are visible alternatives and are never silently interchanged.
Standard component table
| Component | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin, µmol/L | <34 | 34 through 51 | >51 |
| Albumin, g/L | >35 | 28 through 35 | <28 |
| INR | <1.7 | 1.7 through 2.3 | >2.3 |
| PT prolongation, seconds above control | <4 | 4 through 6 | >6 |
| Ascites | None | Mild/moderate, diuretic-responsive | Severe/refractory despite diuretics |
| Encephalopathy | None | West Haven I-II | West Haven III-IV |
The five selected points sum to 5-15: Class A is 5-6, Class B is 7-9, and Class C is 10-15. Raw laboratory values are compared without rounding.
This route does not implement separate PBC, PSC, or other cholestatic bilirubin thresholds.
Applicability and timing
The calculation requires an adult with established chronic liver disease or cirrhosis and a contemporaneous baseline snapshot. Acute liver failure, pediatric use, and use without established chronic liver disease are outside scope.
If INR or PT is confounded by anticoagulation or a nonhepatic coagulation disorder, or if a recent intervention or discordant timepoints prevent a contemporaneous five-component snapshot, the app withholds the total and class. Missing or unknown applicability context returns a neutral incomplete assessment.
In the Liver & HCC Master Panel, BCLC and HKLC receive only a successfully interpreted class from this canonical engine. Invalid, incomplete, outside-scope, confounded, and noncontemporaneous Child-Pugh inputs block those downstream projections. The overall panel remains In review.
Sources
- Child CG, Turcotte JG. Surgery and portal hypertension. PMID 4950264
- Pugh RNH et al. Transection of the oesophagus for bleeding oesophageal varices. PMID 4541913
- Merck Manual Professional: Child-Turcotte-Pugh Scoring System
- U.S. Department of Veterans Affairs: Child-Turcotte-Pugh Calculator
- AASLD: Outpatient Management of Cirrhosis
- OPTN allocation calculators
The linked validation supplement documents implementation verification, not independent clinical validation.