Child-Pugh Score Calculator (cirrhosis)

Understanding the Child-Pugh score calculator — concept and principle

The Child-Pugh score grades how severe chronic liver disease, usually cirrhosis, is. It combines three blood tests and two clinical findings into a total of 5 to 15 points and a class A, B or C. Doctors use it to estimate prognosis, judge whether a patient can tolerate surgery, and adjust the doses of drugs that are cleared by the liver.

Pick one box per row and add the points: the default total of 5 is class A (5–6).

How it is calculated

Each of five items scores 1, 2 or 3 points:

Total bilirubin: under 2 mg/dL = 1, 2–3 mg/dL = 2, over 3 mg/dL = 3.
Serum albumin: over 3.5 g/dL = 1, 2.8–3.5 g/dL = 2, under 2.8 g/dL = 3.
INR: under 1.7 = 1, 1.7–2.3 = 2, over 2.3 = 3.
Ascites: none = 1, mild = 2, moderate to severe = 3.
Hepatic encephalopathy: none = 1, grade 1–2 = 2, grade 3–4 = 3.

Total = sum of the five scores. Class A = 5–6, B = 7–9, C = 10–15.

The principle

The liver makes albumin and clotting factors and clears bilirubin and toxins from the gut. As functioning liver tissue is lost, albumin falls, the INR and bilirubin rise, fluid collects in the abdomen and the brain is affected by unfiltered toxins. Each item is a window on one of those functions, so the sum tracks how much reserve remains. Child and Turcotte proposed the original grading in 1964; Pugh and colleagues in 1973 replaced nutritional status with prothrombin time and introduced the points system used today.

Worked example

Bilirubin under 2 mg/dL = 1 point.
Albumin over 3.5 g/dL = 1 point.
INR under 1.7 = 1 point.
No ascites = 1 point; no encephalopathy = 1 point.
Total = 1 + 1 + 1 + 1 + 1 = 5, which is class A, the best possible score.

How to read the result

Where does your result fall?

Class A indicates well-compensated disease, class B significant functional impairment and class C decompensated disease with a much poorer outlook. Survival falls and surgical risk rises clearly from A to C. Drug labels often give separate dosing advice for Child-Pugh A, B and C. For ranking patients on transplant waiting lists, the more objective MELD score is used instead.

Common mistakes

Using standard bilirubin cut-offs in primary biliary or primary sclerosing cholangitis, where higher bands (1–4, 4–10, over 10 mg/dL) are usually applied.
Scoring ascites that is controlled only by diuretics as "none".
Mixing µmol/L and mg/dL for bilirubin; 2 mg/dL is about 34 µmol/L.
Counting a high INR caused by warfarin as liver dysfunction.

Keep in mind: The score is not a diagnosis. Ascites and encephalopathy are graded subjectively, and the three bands for each item are coarse. Treatment, surgery and dosing decisions belong to the clinical team.

Frequently asked questions

What is the life expectancy for Child-Pugh class C?

Class C carries a high short-term mortality, but individual prognosis depends on the cause, complications and treatment, including transplantation.

What is the difference between Child-Pugh and MELD?

Child-Pugh includes clinical findings and gives a class; MELD uses only laboratory values and predicts 90-day mortality more finely.

Sources: Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973. · Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension, 1964.

Checked 8 Nov 2026. Pugh et al., Br J Surg 1973.

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