Child-Pugh Score Calculator
Child-Pugh Score Calculator
Grade the severity of chronic liver disease from bilirubin, albumin, INR, ascites and encephalopathy, and read off the Child-Pugh class with its survival estimates.
Child-Pugh score
5 items → 5–15 pointsBilirubin 2.4 mg/dL (2), albumin 3.1 g/dL (2), INR 1.4 (1), mild ascites (2), no encephalopathy (1)
How the score is built
- each item
- scores 1, 2 or 3 points
- total
- 5 to 15 points
- class
- A = 5–6, B = 7–9, C = 10–15
Worked example
Bilirubin 2.4 mg/dL (2), albumin 3.1 g/dL (2), INR 1.4 (1), mild ascites (2), no encephalopathy (1)
2 + 2 + 1 + 2 + 1 = 8 points
7–9 points → Class B
Scoring
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin | < 2 mg/dL | 2 – 3 mg/dL | > 3 mg/dL |
| Serum albumin | > 3.5 g/dL | 2.8 – 3.5 g/dL | < 2.8 g/dL |
| INR | < 1.7 | 1.7 – 2.3 | > 2.3 |
| Ascites | None | Mild / diuretic-responsive | Moderate–severe / refractory |
| Encephalopathy | None | Grade I–II | Grade III–IV |
Classes and outcome
| Class | Points | 1-year survival | 2-year survival |
|---|---|---|---|
| A — well compensated | 5 – 6 | ≈ 100% | ≈ 85% |
| B — significant compromise | 7 – 9 | ≈ 81% | ≈ 57% |
| C — decompensated | 10 – 15 | ≈ 45% | ≈ 35% |
How the score is used
Child-Pugh began as a way to predict who would survive portosystemic shunt surgery and became the standard shorthand for describing how decompensated a cirrhotic liver is. Two of its five items are clinical judgements rather than measurements, which is both its weakness — ascites and encephalopathy grading vary between observers — and the reason it captures something a purely biochemical score misses.
In transplant allocation it has largely been replaced by MELD and MELD-Na, which are continuous, objective and better calibrated to short-term mortality. Child-Pugh survives in everyday use because it still governs a great deal of practical decision-making: drug licensing and dose adjustment are written in terms of Child-Pugh class, as are many surgical risk assessments and the eligibility criteria for hepatocellular carcinoma treatments.
A few practical points affect the score in ways that are easy to miss. Albumin falls in any inflammatory or nephrotic state, so a low value is not always hepatic synthetic failure. INR is affected by warfarin and by direct oral anticoagulants, which makes the score unreliable in an anticoagulated patient — MELD-XI exists for exactly that reason. Ascites should be graded on the current clinical state rather than the worst it has ever been, since a patient controlled on diuretics scores two points, not three.
Recalculate after any change in treatment or clinical state. Child-Pugh describes a moment, not a fixed prognosis, and a patient who stops drinking or clears a viral infection can move a full class within months.
Frequently asked questions
What is the difference between Child-Pugh and MELD?
Child-Pugh grades severity into three classes using five items, two of them subjective. MELD is a continuous score computed from bilirubin, creatinine, INR and sodium, designed to predict 90-day mortality, and is what most transplant programmes use for allocation. Child-Pugh remains the standard for drug dosing and surgical risk.
Which bilirubin units does the score use?
The classic thresholds are in mg/dL. In SI units they correspond to roughly under 34 µmol/L, 34–51 µmol/L and over 51 µmol/L.
Can Child-Pugh class improve?
Yes. Alcohol abstinence, viral suppression, diuresis and nutritional support can all move a patient from class C to B or B to A, and the score should be recalculated after any change in clinical state rather than treated as fixed.
Related calculators
References
- Pugh RNH, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.
- Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. 1964:50–64.
Medical Disclaimer: The tools and content provided here are for educational and reference purposes only. They are not intended to substitute for professional medical advice, diagnosis, or treatment. Clinical decisions should always be based on the comprehensive assessment of a qualified healthcare professional.