Child-Pugh Score Calculator

Assess the severity of chronic liver disease and cirrhosis using the Child-Pugh classification. This validated scoring system helps predict prognosis and guides management decisions.

Important Clinical Disclaimer: The Child-Pugh score is intended for use by qualified healthcare professionals only. It is for educational and informational purposes and should not replace clinical judgement. Always interpret results alongside the full clinical picture and follow your local guidelines and protocols.
Child-Pugh Assessment
About the Child-Pugh Score

The Child-Pugh score (also known as Child-Turcotte-Pugh score) is a validated scoring system used to assess the prognosis of chronic liver disease, primarily cirrhosis. It was originally developed to predict surgical risk but is now widely used to classify disease severity.

The Five Parameters:
  • Total bilirubin - measures hepatic excretory function
  • Serum albumin - measures hepatic synthetic function
  • INR/PT - measures coagulation (synthetic function)
  • Ascites - measures portal hypertension
  • Hepatic encephalopathy - measures detoxification function
Clinical Uses:
  • Prognosis assessment in cirrhosis
  • Surgical risk stratification
  • Liver transplant evaluation
  • Drug dosing adjustments

Child-Pugh Classification

Class Points 1-Year Survival 2-Year Survival Description
Class A 5-6 ~100% ~85% Compensated cirrhosis
  • Well-preserved liver function
  • Good surgical candidate
  • Generally good prognosis
Class B 7-9 ~81% ~57% Significant functional compromise
  • Moderate hepatic impairment
  • Increased surgical risk
  • May benefit from transplant evaluation
Class C 10-15 ~45% ~35% Decompensated cirrhosis
  • Severe hepatic impairment
  • High surgical mortality
  • Liver transplant should be considered
Clinical Note:

The survival estimates are approximate and based on historical data. Modern management of cirrhosis complications may improve outcomes. The MELD score is now preferred for liver transplant allocation in the UK and many other countries.

Parameter Details

Laboratory Parameters
Bilirubin

Reflects the liver's ability to conjugate and excrete bilirubin. Elevated levels indicate cholestasis or hepatocellular dysfunction.

Albumin

Synthesised exclusively by the liver. Low levels indicate impaired synthetic function. Half-life ~20 days, so changes reflect chronic dysfunction.

INR / Prothrombin Time

Most clotting factors are synthesised in the liver. Prolonged PT/elevated INR indicates impaired synthetic function. Responds quickly to acute changes.

Clinical Parameters
Ascites

Fluid accumulation in the peritoneal cavity due to portal hypertension and hypoalbuminaemia. Grading:

  • Mild: Only detectable on ultrasound
  • Moderate: Moderate symmetrical distension
  • Severe: Marked distension, may be tense
Hepatic Encephalopathy

Neuropsychiatric syndrome due to liver dysfunction. West Haven criteria:

  • Grade I: Mild confusion, altered mood
  • Grade II: Drowsiness, inappropriate behaviour
  • Grade III: Somnolent but rousable
  • Grade IV: Coma, unresponsive

Limitations

Limitations of the Child-Pugh Score
  • Subjective components - ascites and encephalopathy grading varies between assessors
  • Ceiling effect - limited discrimination among sickest patients (all score Class C)
  • Treatment effects - diuretics affect ascites, lactulose affects encephalopathy
  • Not validated for acute liver failure
  • Does not account for renal function - an important prognostic factor
  • Limited range - only 5-15 points possible
MELD Score Comparison

The Model for End-Stage Liver Disease (MELD) score is an alternative that:

  • Uses only objective laboratory values (bilirubin, INR, creatinine)
  • Has a continuous scale (6-40) with better discrimination
  • Includes renal function
  • Is used for liver transplant allocation
  • Better predicts short-term mortality (3 months)

Both scores are complementary - Child-Pugh for clinical staging, MELD for transplant listing.

Frequently Asked Questions

Both scores assess liver disease severity but have different characteristics:

Child-Pugh MELD
Includes clinical parameters (ascites, encephalopathy) Uses only laboratory values
Categorical (Class A, B, C) Continuous scale (6-40)
Useful for clinical staging Used for transplant allocation
Does not include renal function Includes creatinine

The Child-Pugh score is useful for:

  • Clinical classification of cirrhosis severity (compensated vs decompensated)
  • Surgical risk assessment - perioperative mortality increases with higher class
  • Drug dosing - many drugs require dose reduction in Child-Pugh B or C
  • Prognosis discussions with patients and families
  • Research - for patient stratification in clinical trials

Compensated cirrhosis (generally Child-Pugh A):

  • Liver function is maintained despite structural damage
  • No major complications (ascites, encephalopathy, variceal bleeding)
  • Patients may be asymptomatic

Decompensated cirrhosis (Child-Pugh B or C):

  • Liver function has deteriorated significantly
  • Presence of complications: ascites, encephalopathy, variceal bleeding, jaundice
  • Transition to decompensation is a critical prognostic event

Yes, the Child-Pugh score can improve if:

  • Underlying cause is treated - e.g., alcohol abstinence, antiviral therapy for hepatitis B/C
  • Complications are controlled - diuretics for ascites, lactulose for encephalopathy
  • Nutritional status improves - protein intake, vitamin supplementation

However, established cirrhosis is generally irreversible, and the score reflects functional reserve rather than structural damage.

Surgical risk increases with higher Child-Pugh class:

  • Class A: ~10% perioperative mortality - generally acceptable surgical risk
  • Class B: ~30% perioperative mortality - proceed with caution, optimise first
  • Class C: ~80% perioperative mortality - surgery often contraindicated unless life-saving

These figures are approximate and depend on the type of surgery. Elective surgery is generally avoided in Class C patients.

Disclaimer

This calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

  • Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
  • Never disregard professional medical advice or delay seeking it because of information from this tool.
  • Clinical decision-making should always incorporate the full clinical context, patient preferences, and local protocols.
  • The creators of this tool accept no liability for decisions made based on its output.

If you are a patient: please discuss any results with your healthcare provider. This tool is designed for use by medical professionals and may not be appropriate for self-assessment.

References

  1. Pugh RN, et al. (1973). Transection of the oesophagus for bleeding oesophageal varices. British Journal of Surgery, 60(8), 646-649.
  2. Child CG, Turcotte JG. (1964). Surgery and portal hypertension. In: The Liver and Portal Hypertension. Philadelphia: Saunders, 50-64.
  3. NICE. Cirrhosis - NICE Clinical Knowledge Summaries.
  4. European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 69(2), 406-460.
  5. Kamath PS, Kim WR. (2007). The model for end-stage liver disease (MELD). Hepatology, 45(3), 797-805.