Child-Pugh Score
Inputs
| Ascites | None |
|---|---|
| Hepatic encephalopathy | None |
Visualization
| Parameter | Points |
|---|---|
Total bilirubin | 0 |
Serum albumin | 0 |
INR | 0 |
Ascites | 0 |
Hepatic encephalopathy | 0 |
Child-Pugh Score
Calculate the Child-Pugh (Child-Turcotte-Pugh) score from bilirubin, albumin, INR, ascites, and encephalopathy to grade cirrhosis severity as Class A, B, or C.
Inputs
Clinical inputs
Results
Enter a value to see results.
This calculator is for education and general reference, not a medical diagnosis or treatment plan. The Child-Pugh score is one of several tools (alongside MELD/MELD-Na) used to stratify cirrhosis severity; ascites and encephalopathy grading is subjective. Interpret results with a qualified clinician.
Child-Pugh Score
The Child-Pugh score, originally the Child-Turcotte-Pugh classification, grades how advanced chronic liver disease has become. It condenses five routine findings into a single number from 5 to 15 and a class of A, B, or C. Hepatologists, surgeons, and pharmacists use it to estimate prognosis, gauge the risk of surgery in a patient with cirrhosis, adjust drug dosing, and frame conversations about transplant referral.
The five parameters
Each parameter scores 1, 2, or 3 points, and the points are summed. Three are laboratory values and two are clinical assessments.
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin (mg/dL) | below 2 | 2–3 | above 3 |
| Serum albumin (g/dL) | above 3.5 | 2.8–3.5 | below 2.8 |
| INR | below 1.7 | 1.7–2.3 | above 2.3 |
| Ascites | none | mild (diuretic-controlled) | moderate–severe (refractory) |
| Encephalopathy | none | grade 1–2 (controlled) | grade 3–4 (refractory) |
Bilirubin reflects the liver's excretory capacity, while albumin and INR reflect its synthetic function — the ability to make proteins and clotting factors. A value sitting exactly on a cutoff is scored in the inclusive middle band, matching the MDCalc convention: bilirubin of 2 or 3, albumin of 3.5 or 2.8, and INR of 1.7 or 2.3 each score 2 points.
The values can be entered in either conventional or SI units. Bilirubin converts as 1 mg/dL = 17.1 µmol/L and albumin as 1 g/dL = 10 g/L, so the same thresholds become bilirubin below 34 / above 50 µmol/L and albumin above 35 / below 28 g/L. INR is a ratio and carries no units.
Classes and prognosis
The total score maps to three classes:
Class=⎩⎨⎧ABC5≤score≤67≤score≤910≤score≤15Class A describes well-compensated cirrhosis, Class B significant functional compromise, and Class C decompensated disease. Historical cohorts associate the classes with progressively lower survival — roughly 100%, 80%, and 45% at one year for A, B, and C respectively, with StatPearls reporting one-year mortality of about 0%, 20%, and 55%. These are population averages from older literature and vary widely with the cause of liver disease, comorbidity, and modern treatment, so they describe groups rather than any individual.
A short history
Charles Gardner Child and Jeremiah Turcotte introduced the original classification in 1964 to predict surgical risk in patients with cirrhosis undergoing portal-systemic shunt operations. Their version used nutritional status as a parameter. In 1973, Pugh and colleagues modified it for patients having surgery for bleeding varices, replacing nutritional status with the prothrombin time (now expressed as INR) and adding the formal grading of encephalopathy. That modification is the score in use today.
Child-Pugh versus MELD
The Child-Pugh score includes two subjective elements — the clinician's grading of ascites and of encephalopathy — which makes it quick at the bedside but somewhat observer-dependent. The Model for End-Stage Liver Disease (MELD), and its sodium-adjusted form MELD-Na, was developed to be fully objective, calculated only from bilirubin, INR, creatinine, and sodium. Because it is reproducible, MELD is used to rank patients for liver-transplant allocation. Child-Pugh remains widely used for its simplicity and for stratifying surgical and medication risk. The kidney function that feeds MELD can be estimated with the Creatinine Clearance Calculator, and the Corrected Calcium Calculator is another bedside lab adjustment often checked alongside it.
Limitations
Two of the five inputs depend on clinical judgment, so scores can differ between assessors. The bands are coarse, so a patient near a cutoff can shift class with a small lab change, and the score does not capture kidney function, the cause of liver disease, or response to treatment. Importantly, the class is dynamic: treating the underlying disease can lower bilirubin and INR, raise albumin, and resolve ascites, moving a patient from Class B back to Class A. The score should be read alongside the full clinical picture rather than on its own.
Frequently Asked Questions (FAQ)
What is the Child-Pugh score used for?
The Child-Pugh score (originally the Child-Turcotte-Pugh classification) grades the severity of chronic liver disease, mainly cirrhosis. It combines two lab markers of synthetic function (albumin and INR), one of excretory function (bilirubin), and two clinical findings (ascites and hepatic encephalopathy).
The total places a patient in Class A, B, or C, which helps estimate prognosis and informs surgical risk, drug dosing, and discussions about transplant referral.
What is the difference between Child-Pugh and MELD?
Both grade cirrhosis severity, but they differ in design. Child-Pugh includes two subjective clinical assessments — the grade of ascites and of encephalopathy — alongside lab values.
MELD (and MELD-Na) is fully objective, calculated only from bilirubin, INR, creatinine, and sodium, which makes it reproducible enough to rank patients for liver-transplant allocation. Child-Pugh remains popular for its simplicity and for risk-stratifying surgery and medication dosing.
What do Class A, B, and C mean?
Class A (5–6 points) is well-compensated disease with the best prognosis. Class B (7–9 points) indicates significant functional compromise. Class C (10–15 points) is decompensated cirrhosis with the poorest prognosis and the strongest case for transplant evaluation. The classes correspond to progressively lower historical survival rates, but those figures are population averages rather than individual predictions.
Which lab units does this calculator accept?
Bilirubin can be entered in mg/dL or µmol/L (1 mg/dL = 17.1 µmol/L), and albumin in g/dL or g/L (1 g/dL = 10 g/L); switch units on the input field and the scoring adjusts automatically. INR is a ratio and has no units. The point thresholds are identical regardless of unit — only the displayed number changes.
How are ascites and encephalopathy graded?
Ascites is graded by clinical examination and imaging as none, mild (responsive to diuretics), or moderate-to-severe (tense or refractory) — scoring 1, 2, or 3 points. Hepatic encephalopathy uses the West Haven criteria: none (1 point), grade 1–2 (mild confusion or lethargy, controlled) for 2 points, and grade 3–4 (marked disorientation through coma, refractory) for 3 points.
Both rely on clinical judgment, which is why the score has a subjective element.
Can the Child-Pugh class improve over time?
Yes. The score is dynamic, not fixed. Treating the underlying liver disease — for example controlling viral hepatitis, stopping alcohol, or optimizing diuretics and nutrition — can lower bilirubin and INR, raise albumin, and resolve ascites or encephalopathy. A patient can move from Class B back to Class A, which is why the score is often repeated as the clinical picture changes.
Is the Child-Pugh score a diagnosis?
No. The Child-Pugh score is a severity and prognostic stratification tool, not a diagnostic test. It assumes cirrhosis or chronic liver disease has already been diagnosed and then describes how advanced it is. It does not identify the cause of liver disease or replace imaging, biopsy, or specialist assessment.
Disclaimer
This calculator is for education and general reference, not a medical diagnosis or treatment plan. The Child-Pugh score is one of several tools (alongside MELD/MELD-Na) used to stratify cirrhosis severity; ascites and encephalopathy grading is subjective. Interpret results with a qualified clinician.