Moderate hepatic dysfunction (Child-Pugh B, score 7-9). Triggers dose modification or sub...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ORGAN-HEPATIC-CHILD-PUGH-B`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	Moderate hepatic dysfunction (Child-Pugh B, score 7-9). Triggers dose modification or substitution for hepatically metabolized drugs: doxorubicin, vincristine, vinblastine, paclitaxel, docetaxel, etoposide, sorafenib, atezolizumab + bevacizumab caution; bilirubin and AST/ALT-driven attenuation per FDA labels.
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "all_of": [
    {
      "finding": "child_pugh_class",
      "value": "B"
    }
  ],
  "type": "composite_score"
}

Notes

Child-Pugh B is the most clinically nuanced hepatic-dysfunction tier — many systemic-therapy trials (atezo+bev for HCC, sorafenib) limit to Child-Pugh A or carefully selected B7. Doxorubicin: 50% reduction at bilirubin 1.5-3 mg/dL, 75% at 3-5; vincristine: 50% reduction at bilirubin 1.5-3, hold ≥3; paclitaxel: dose reduction per total bilirubin; etoposide reduce 50% at bilirubin 1.5-3. R-CHOP feasible at Child-Pugh B with vincristine substitution / dose attenuation. Sorafenib safe at Child-Pugh B7 (SHARP subgroup, GIDEON registry); avoid at B8-9. For HCC-specific dosing see RF-HCC-CHILD-PUGH-B-C.

Used By

Algorithms

ALGO-HCC-SYSTEMIC-1L - ALGO-HCC-SYSTEMIC-1L