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In transplant allocation it has largely been replaced by MELD and MELD-Na, which are continuous, objective and better calibrated to short-term mortality.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.
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/