The Child-Turcotte criteria (CTC) (based on serum bilirubin and albumin, ascites, neurological disorder and nutrition) are established prognostic factors in patients with cirrhosis having portacaval shunt surgery. The objective of this study was to evaluate the prognostic value of CTC in conservatively treated cirrhosis. Patients (n = 245) with histologically verified cirrhosis from a control group of a controlled clinical trial were studied. Data at entry into the trial were used to classify patients according to CTC. Survival curves for up to 16 years were made, and survival rates were compared using the log-rank test. Survival decreased significantly with increasing degree of abnormality (A + B 4 C) of albumin (p < 0.001), ascites (p < 0.001), bilirubin (p = 0.02) and nutritional status (p = 0.03). Survival was insignificantly influenced by neurological status (p = 0.11) probably because none of the patients had hepatic coma at entry into the trial. The five variables in CTC were combined to a score. With increasing score, the median survival time decreased from 6.4 years (score 5) to 2 months (scores 12 or more). Furthermore, the mortality from hepatic failure, gastrointestinal bleeding or hepatocellular carcinoma increased significantly with increasing score. CTC provide valuable and easily obtainable prognostic information in cirrhosis. However, CTC are inferior to a prognostic index based on multivariate analysis of prognostic factors.
In 1964, Child and Turcotte (1) published criteria for assessment of hepatocellular functional reserve to improve selection of candidates for portosystemic shunts. The relation of the Child-Turcotte criteria (CTC) to short-and long-term survival after portosystemic shunt operation has been investigated in several studies (2-111, showing that CTC has prognostic significance. However, CTC is of limited value in predicting the therapeutic effect of portal-systemic shunt (12, 13).
This report describes the prognostic significance of