The Child–Turcotte Classification: From Gestalt to Sophisticated Statistics and Back

Excerpt

In a landmark article published 52 years ago, Child and Turcotte, two surgeons who performed portacaval shunt surgery, classified patients with cirrhosis in three “functional hepatic reserve” categories: A, B, and C, corresponding to minimally, moderately, and severely altered hepatic functional reserve, respectively [1]. This classification was based on five variables, three clinical (ascites, encephalopathy, and nutritional status), and two biochemical (serum albumin and bilirubin). Notably, the selection of these variables was based on clinical experience and not on multivariable analysis, which at the time was not widely used, although they did perform actuarial survival analysis to demonstrate statistically significant differences for the probabilities of 3- and 10-year survival among the three groups. …