Child-Pugh Score Calculator — Cirrhosis Severity Classification

How to Use This Calculator

1. Enter bilirubin and albumin from recent labs.
2. Enter INR.
3. Select ascites severity and encephalopathy grade.
4. Child-Pugh score, class, and 1-year survival display instantly.
5. Use the Surgical Risk tab for operative mortality estimates.

Formula

Example

Frequently Asked Questions

• What is the Child-Pugh score? ▼
  The Child-Pugh score is a clinical grading system used to assess the severity of chronic liver disease, particularly cirrhosis, by quantifying the degree of hepatic functional reserve. Originally described by Child and Turcotte in 1964 and modified by Pugh et al. in 1973, the score assigns 1–3 points to each of five clinical parameters: total bilirubin (reflecting hepatic excretory function), serum albumin (reflecting synthetic function), prothrombin time or INR (reflecting coagulation factor synthesis), degree of ascites (reflecting portal hypertension and sodium handling), and degree of hepatic encephalopathy (reflecting hepatic detoxification). Points are summed to produce a total score of 5–15. Patients are classified into three prognostic classes: Class A (5–6 points) indicates mild/compensated cirrhosis with good hepatic reserve; Class B (7–9 points) indicates moderate/functional compromise; Class C (10–15 points) indicates severe decompensated cirrhosis with poor prognosis. The score was initially developed to stratify surgical risk before portocaval shunt surgery but has since been validated across a wide range of clinical decisions in cirrhotic patients.
• How does Child-Pugh compare to MELD? ▼
  Child-Pugh and MELD are both validated cirrhosis severity scores, but they differ fundamentally in design and intended use. Child-Pugh uses five variables (three laboratory, two clinical) each discretely scored 1–3, making it simple and quick to apply at the bedside without a calculator. MELD uses only three continuous laboratory variables (creatinine, bilirubin, INR) in a logarithmic formula, producing a more granular continuous score. Key differences: Child-Pugh includes subjective clinical variables (ascites grade, encephalopathy grade) that introduce inter-observer variability; MELD is fully objective. MELD provides better discrimination and calibration for 90-day mortality prediction, which is why UNOS replaced Child-Pugh with MELD for transplant allocation in 2002. However, Child-Pugh retains important advantages: it captures hepatic encephalopathy and ascites status — decompensation markers that MELD ignores but which have profound clinical significance; it is more intuitive and applicable in resource-limited settings; and it has been specifically validated for surgical risk stratification and drug dosing guidance. In practice, both scores are often calculated together to provide a comprehensive picture.
• When is Child-Pugh A vs C important clinically? ▼
  The Child-Pugh class significantly impacts multiple clinical decisions. For surgical risk, Child-Pugh A carries approximately 10% operative mortality for abdominal surgery, Child-Pugh B carries 25–30%, and Child-Pugh C carries 50–80% — making elective surgery generally contraindicated in Child-Pugh C patients and requiring careful multidisciplinary assessment in Child-Pugh B. Survival estimates also differ markedly: 1-year survival is approximately 100% in Child-Pugh A, 80% in B, and only 45% in C, with 2-year survival of approximately 85%, 60%, and 35% respectively. For TIPS (transjugular intrahepatic portosystemic shunt), Child-Pugh C is a relative contraindication due to high encephalopathy risk. For drug dosing, Child-Pugh C requires major dose reductions for hepatically-metabolised drugs (beta-blockers, antibiotics, anticoagulants) and contraindications to NSAIDs and many other agents. For prognosis discussions, Child-Pugh class is a robust predictor that is understood by most clinicians globally. In hepatocellular carcinoma staging systems (Barcelona Clinic Liver Cancer algorithm), Child-Pugh class directly determines which treatment options are available — only Child-Pugh A patients are candidates for surgical resection.
• Why is albumin included in Child-Pugh? ▼
  Serum albumin is included in the Child-Pugh score as a marker of hepatic synthetic function — the liver produces virtually all circulating albumin, and albumin synthesis is reduced progressively as hepatocyte mass and function decline in cirrhosis. Albumin also reflects nutritional status, as it serves as a transport protein and oncotic pressure determinant. In cirrhosis, low albumin (hypoalbuminaemia) contributes directly to ascites formation by reducing the oncotic component of the Starling forces that govern fluid movement across capillaries — low plasma oncotic pressure promotes transudation of fluid into the peritoneal cavity. Clinically, albumin below 2.8 g/dL is scored 3 points in Child-Pugh, reflecting severely impaired synthetic function. Albumin levels may also be influenced by acute phase reactions (albumin is a negative acute phase reactant — it falls during acute illness), malnutrition, protein-losing enteropathy, and nephrotic syndrome, which limits its specificity as a liver disease marker. Despite this, albumin remains clinically informative in the chronic cirrhosis context. Its inclusion in the Child-Pugh score is validated by multiple prognostic studies, and albumin's importance is further underscored by its inclusion in MELD 3.0.
• Can Child-Pugh class change over time? ▼
  Yes — Child-Pugh class is dynamic and can change over time in either direction. Decompensation events (development of ascites, variceal haemorrhage, hepatic encephalopathy, jaundice, hepatorenal syndrome) typically cause rapid worsening from Child-Pugh A to B or B to C. Conversely, optimal medical management, treatment of the underlying aetiology, or resolution of a precipitating event can lead to re-compensation and improvement in class. The most dramatic example is treatment of hepatitis C cirrhosis with direct-acting antivirals (DAAs): achieving sustained virological response (SVR) in Child-Pugh B or C patients with HCV-related cirrhosis frequently results in improvement of Child-Pugh score, sometimes to Child-Pugh A, particularly if patients are treated before severe decompensation. Abstinence from alcohol in alcoholic cirrhosis also leads to measurable improvement in Child-Pugh score over weeks to months if decompensation features resolve. Serial Child-Pugh assessments every 3–6 months are clinically valuable for tracking disease trajectory, timing of transplant referral, and identifying patients who have re-compensated and may tolerate surgical procedures or additional therapies.

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