Severe hepatic dysfunction (Child-Pugh C, score 10-15). Effectively contraindicates most...

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-C`
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	Severe hepatic dysfunction (Child-Pugh C, score 10-15). Effectively contraindicates most cytotoxic and targeted systemic therapy. Best-supportive-care or strictly palliative regimens only; trial participation excluded. Liver transplant evaluation may take precedence over oncologic therapy in HCC.
Clinical direction	hold
Category	organ-dysfunction

Trigger Logic

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

Notes

Child-Pugh C exclusion is near-universal across systemic-therapy trials. In HCC: only BSC or hospice referral typically; selected centers offer Y90 radioembolization in CP-C7-with-good-PS, but no systemic standard. In hematologic malignancies with secondary hepatic involvement (Hodgkin, DLBCL infiltrating liver), pre-phase prednisolone alone may improve LFTs sufficiently to allow attenuated R-CVP within 1-2 weeks — reassess after pre-phase. Direction `hold` rather than `de-escalate` because no evidence-supported attenuation guarantees safety here.

Used By

Algorithms

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