Correct Answer: A. Class B
The Child-Turcotte-Pugh (CTP) score is the gold standard for assessing hepatic synthetic function and predicting prognosis in cirrhosis. It combines five clinical and laboratory parameters, each scored 1–3 points. The patient's parameters map as follows: serum bilirubin 2.5 mg/dL (score 2, range 1.5–3.0), serum albumin 3 g/dL (score 2, range 2.8–3.5), prothrombin time INR 2 (score 2, range 1.3–2.0), no encephalopathy (score 1), and mild ascites (score 1). Total score = 2 + 2 + 2 + 1 + 1 = 8 points, which falls in the Class B range (7–9 points). Class B indicates moderate hepatic dysfunction with a 1-year survival of 80% and 2-year survival of 60%. This score is critical in India for triaging cirrhotic patients for transplant eligibility, TIPS candidacy, and prognostic counseling. The CTP score remains the most widely used bedside tool in Indian hepatology practice, though MELD has supplemented it for transplant allocation.
Why the other options are wrong
B. Class C — Class C (score 10–15) represents decompensated cirrhosis with severe hepatic dysfunction and 1-year survival <50%. This patient's total score of 8 does not meet the threshold for Class C. Selecting this reflects misunderstanding of the CTP scoring cutoffs—a common NBE trap where students confuse the numerical ranges. C. Class D — Class D is not a recognized CTP classification; the system only includes Classes A, B, and C. This is a distractor for students unfamiliar with the formal CTP grading scheme. Some may confuse it with other liver severity scores or incorrectly assume a fourth category exists. D. Class A — Class A (score 5–6) represents compensated cirrhosis with minimal hepatic dysfunction and near-normal 1-year survival (~95%). This patient's bilirubin, albumin, and INR are all elevated beyond the Class A thresholds, making this incorrect. Students may select this if they underestimate the severity of the laboratory derangements.
High-Yield Facts
- CTP Class B score range is 7–9 points, representing moderate hepatic dysfunction with ~80% 1-year survival.
- Serum bilirubin 2.5 mg/dL scores 2 points (range 1.5–3.0 mg/dL); >3.0 scores 3 points.
- Serum albumin 3 g/dL scores 2 points (range 2.8–3.5 g/dL); <2.8 scores 3 points.
- INR 2 scores 2 points (range 1.3–2.0); >2.0 scores 3 points.
- Encephalopathy and ascites are graded 1 (none/mild), 2 (moderate), 3 (severe); this patient scores 1 for each.
- CTP score guides TIPS, transplant eligibility, and variceal bleeding risk in Indian cirrhotic populations.
Mnemonics
CTP Scoring Tiers A (5–6): Almost normal, 95% 1-yr survival. **B** (7–9): Bad but stable, 80% 1-yr survival. C (10–15): Critical, <50% 1-yr survival. Use this to anchor the three classes and their prognoses. CTP Five Parameters (ABATE) Albumin, Bilirubin, Ascites, Time (PT/INR), Encephalopathy. Each scored 1–3; total 5–15 points. Helps recall all five variables systematically.
NBE Trap
NBE pairs borderline Class B scores (7–9) with Class C distractors to test whether students can accurately sum the five parameters and apply the correct cutoff. Students who miscount or confuse the bilirubin/albumin/INR thresholds often jump to Class C.
Clinical Pearl
In Indian hepatology practice, a Class B CTP score signals the need for close surveillance and consideration of TIPS or transplant listing if decompensation occurs. Many Indian cirrhotic patients present at Class B or C due to delayed diagnosis of underlying viral hepatitis or alcohol-related liver disease.
_Reference: Harrison Ch. 297 (Cirrhosis and Portal Hypertension); Robbins Ch. 18 (Liver and Biliary Tract)_