What is Child-Turcotte-Pugh (CTP) system and how is it used to predict life expectancy in patients with cirrhosis?

Updated: Oct 15, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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For many years, the most common prognostic tool used in patients with cirrhosis was the Child-Turcotte-Pugh (CTP) system. Child and Turcotte first introduced their scoring system in 1964 as a means of predicting the operative mortality associated with portocaval shunt surgery. Pugh's revised system in 1973 substituted albumin for the less specific variable of nutritional status. [54] Subsequent revisions have used the International Normalized Ratio (INR) in addition to prothrombin time.

Epidemiologic work shows that the CTP score may predict life expectancy in patients with advanced cirrhosis. A CTP score of 10 or greater is associated with a 50% chance of death within 1 year. (See Table 4, below.)

Table 4. Child-Turcotte-Pugh Scoring System for Cirrhosis (Open Table in a new window)

Clinical Variable

1 Point

2 Points

3 Points



Grade 1-2

Grade 3-4




Moderate or large

Bilirubin (mg/dL)

< 2



Bilirubin in PBC* or PSC** (mg/dL)

< 4



Albumin (g/dL)



< 2.8

Prothrombin time(seconds prolonged or INR)

< 4 s or INR < 1.7

4-6 s or INR 1.7-2.3

>6 s or INR >2.3

*PBC = Primary biliary cholangitis

**PSC = Primary sclerosing cholangitis

Child Class A = 5-6 points, Child Class B = 7-9 points, Child Class C = 10-15 points

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