Cirrhosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]Sudarshana Datta, MD [3]


Cirrhosis of the liver may be classified using two classification methods based on etiology and morphology. Currently, classifying cirrhosis based on morphology is not recommended, as it requires an invasive procedure to examine the gross appearance of the liver, and provides little diagnostic value. Classifying cirrhosis according to etiology is a more acceptable form of classification, as it may be attained through non-invasive laboratory testing, and has a higher diagnostic value.

Classification Based On Etiology

Cirrhosis may be classified on the basis of etiology. This is the most widely accepted method of classification.

(a) Alcoholic cirrhosis

  • Most common cause of cirrhosis
  • Caused by continuous and prolonged alcohol abuse
  • According to American Academy of Family Physicians (AAFP), approximately 60-70 percent of all cases of cirrhosis are due to alcohol abuse

(b) Post-necrotic cirrhosis

(c) Biliary cirrhosis

(d) Cardiac cirrhosis

(e) Cirrhosis due to genetic disorders

(f) Cirrhosis due to malnutrition

Classification Based On Morphology

Cirrhosis has historically been classified based upon the nodular morphology that is seen on upon the gross appearance of the liver. Accurate assessment of the liver morphology can only be obtained through surgery, biopsy, or autopsy, therefore more recently, more non-invasive means of classifying and determining the causes of cirrhosis are used.

Micronodular Macronodular Mixed
Micronodular cirrhosis is characterized by nodules that are less than 3mm in diameter Macronodular cirrhosis is characterized by nodules that are more than 3mm in diameter Micronodular cirrhosis can often progress into macronodular cirrhosis. During this transformation, a mixed form of cirrhosis may be seen.[1]


Mixed nodular cirrhosis is also seen in Indian childhood cirrhosis. [2]

Classification Based On Severity

  • Child-Pugh scoring system is used for predicting the risk of complications and severity of cirrhosis.
  • The Child-Pugh score employs five clinical measures of liver disease. Each measure is scored 1-3, with 3 indicating most severe derangement.
Measure 1 point 2 points 3 points units
Bilirubin (total) <34.2 (<2) 34.2-51.3 (2-3) >51.3 (>3) μmol/l (mg/dL)
Serum albumin >35 28-35 <28 g/L
INR <1.7 1.71-2.3 > 2.3 no unit
Ascites None Suppressed with medication Refractory no unit
Hepatic encephalopathy None Grade I-II (or suppressed with medication) Grade III-IV (or refractory) no unit
  • It should be noted that different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.
  • If the PT is <4 seconds than control, it is assigned 1 point.
  • If the PT is 4-6 seconds over control, then it scores 2 points and if PT is >6 seconds over control, it scores 3 points.
  • In primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels:
    • The upper limit for 1 point is 68 μmol/l (4 mg/dL) and the upper limit for 2 points is 170 μmol/l (10 mg/dL).


  • Chronic liver disease is classified into Child-Pugh class A to C:
Points Class One year survival Two year survival
5-6 A (Compensated cirrhosis) 100% 85%
7-9 B (Failing) 80% 60%
10-15 C (Decompensated cirrhosis) 45% 35%


  1. Fauerholdt L, Schlichting P, Christensen E, Poulsen H, Tygstrup N, Juhl E (1983). "Conversion of micronodular cirrhosis into macronodular cirrhosis". Hepatology. 3 (6): 928–31. PMID 6629323.
  2. Nayak NC, Ramalingaswami V (1975). "Indian childhood cirrhosis". Clin Gastroenterol. 4 (2): 333–49. PMID 47794.
  3. de Franchis R, Primignani M (1992). "Why do varices bleed?". Gastroenterology Clinics of North America. 21 (1): 85–101. PMID 1568779. |access-date= requires |url= (help)

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