British Liver Trust

liver disease grading?

Hello everyone, hope you are all okay under the circumstances. A bit of a dumb question, and I am asking as I don't google as I tend to scare myself but what do my gradings mean. I was told my "stage" about 3 years ago was 2 by Gastroenterologist, and on my first appointment with hepatologist last Autumn was "Child Pugh A". What are the differences and are these figures anything to panic about. I have cirhossis, portal hypertension, 6 banded varicies done between last May and September. What is the difference between Stage results and Child Pugh.

Hope someone can enlighten me.

Best wishes


5 Replies

I think you're OK actually, Child Pugh A is the lowest from A to C.

More information here


I wish I could copy and past figures here, but don't know how to from my iPad.

You are right not to Google, it can get quite confusing.

If your "stage" was calculated from a biopsy and the doctors used the Ishak scoring system, then this goes from 0 = no damage up to 6 = cirrhosis. 3 is half way! So at Stage 3 the person has fibrosis but not cirrhosis.

There is another part to consider which is what I think they call "grading" which is the speed of damage or the level of inflammation. The higher that number the faster the damage is progressing.

People who have removed the cause of their liver damage will hopefully have a slower speed of damage compared to people who are, say, still drinking or eating badly or have active viral hepatitis or active untreated autoimmune.

Symptoms like ascites and portal hypertension usually only start once the liver has cirrhosis, so your liver may now be a different stage to when yours was measured 3 years ago.

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Hi Bolly, thanks for reply, my mistake is was "grade 2" not "stage". Used the wrong word. The fact I have cirhossis is obviously due to liver deterioration since the first liver failure in 2010, then 2013. Then the added complications of portal hypertension and varicies are a reflection of that deterioration. My hepatology appointment keep gets being put back. Have my ultrasound regarding catheter situation on 23rd February by the way and you were right in one of your replies - I am going to be taught to do it myself. Just waiting for an appointment for the specialist nurse to show me how to self catheterise.

best wishes and thanks



The grading or level of inflammation is more complicated to work out because they look at things like how many dead liver cells there are in the sample compared to healthy ones and how much inflammation there is. My Ishak grading is what they call "modified HAI" and I score 2+2+3 from different elements which equals a grade of 7 though my Stage is only 1. Grade 3 sounds pretty good compared to that, especially as you could go up to 18 with this system. But we don't know by what system you were graded so it's not really useful to guess!

You really need either your actual biopsy report or a chat with your specialist to update yourself on where you are now with your cirrhosis.


Thanks for that. Hepatologist in March so question time again.


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