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Calculate the Child-Pugh score to assess chronic liver disease severity. This classification system evaluates five clinical parameters to determine liver function and guide treatment decisions for patients with cirrhosis.
Score Range: 5-15
Sum of 5 parameters scored 1-3 each
3 Classes: A, B, C
From well-compensated to decompensated
Used Since 1964
Modified by Pugh in 1973
Total Score
5 / 15
Class A — Well-Compensated
The Child-Pugh score (also called the Child-Turcotte-Pugh score or CTP score) is one of the most widely used scoring systems for evaluating the prognosis of chronic liver disease, especially cirrhosis. Originally developed by Child and Turcotte in 1964 and later modified by Pugh in 1973, this classification system assesses liver function using five clinical and laboratory parameters.
The score was initially designed to predict surgical mortality in patients undergoing portosystemic shunt surgery. Over time, it has become a standard tool in hepatology for assessing overall liver disease severity, guiding treatment decisions, and estimating life expectancy in patients with cirrhosis from any cause, including alcoholic liver disease, hepatitis B, hepatitis C, and nonalcoholic steatohepatitis (NASH).
Each of the five parameters receives a score of 1, 2, or 3 points based on severity, producing a total that ranges from 5 (best function) to 15 (worst function). Patients are then classified into one of three groups: Class A (well-compensated), Class B (significant functional compromise), or Class C (decompensated liver disease). This child-pugh classification helps clinicians stratify risk and plan appropriate interventions.
Calculating the Child-Pugh score requires five pieces of clinical information. Here is a step-by-step guide to using this calculator:
You need three laboratory values from a recent blood test: total bilirubin (measured in mg/dL), serum albumin (measured in g/dL), and INR or International Normalized Ratio (a measure of how long blood takes to clot). These tests are part of a standard liver function panel and comprehensive metabolic panel.
Two parameters are based on clinical examination: the presence and severity of ascites (abnormal fluid accumulation in the abdomen) and the grade of hepatic encephalopathy (brain dysfunction resulting from the liver's inability to clear toxins). Ascites is typically detected by physical examination or ultrasound, and encephalopathy is graded by clinical assessment of mental status.
Select the appropriate range for each of the five parameters in the calculator above. Each parameter receives 1, 2, or 3 points. The calculator automatically sums the points and displays the total score along with the corresponding Child-Pugh class (A, B, or C).
Example 1: Class A Patient
Total bilirubin 1.5 mg/dL (1 pt) + Albumin 3.8 g/dL (1 pt) + INR 1.3 (1 pt) + No ascites (1 pt) + No encephalopathy (1 pt) = 5 points = Class A
Example 2: Class B Patient
Total bilirubin 2.5 mg/dL (2 pts) + Albumin 3.0 g/dL (2 pts) + INR 1.9 (2 pts) + Mild ascites (2 pts) + No encephalopathy (1 pt) = 9 points = Class B
Example 3: Class C Patient
Total bilirubin 4.2 mg/dL (3 pts) + Albumin 2.1 g/dL (3 pts) + INR 2.8 (3 pts) + Moderate ascites (3 pts) + Grade 2 encephalopathy (2 pts) = 14 points = Class C
The table below shows the exact point values for each of the five parameters used in the Child-Pugh score. Each parameter is scored independently and then summed for the total liver disease score.
| 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 (Prothrombin Time) | < 1.7 | 1.7 - 2.3 | > 2.3 |
| Ascites | None | Mild | Moderate to Severe |
| Hepatic Encephalopathy | None | Grade 1-2 | Grade 3-4 |
The Child-Pugh classification divides patients into three prognostic groups. Each class carries different implications for survival, surgical risk, and treatment planning.
| Class | Score | Description | 1-Year Survival | 2-Year Survival | Perioperative Mortality |
|---|---|---|---|---|---|
| A | 5 - 6 | Well-compensated cirrhosis | 100% | 85% | 10% |
| B | 7 - 9 | Significant functional compromise | 81% | 57% | 30% |
| C | 10 - 15 | Decompensated cirrhosis | 45% | 35% | 80%+ |
Class A patients have well-preserved liver function and can generally undergo surgery safely. Class B patients have moderately impaired liver function and require careful perioperative planning. Class C patients have severely compromised liver function, and elective surgery is typically contraindicated due to unacceptably high mortality rates. Liver transplantation may be considered for Class C patients with appropriate indications.
Several scoring systems exist for evaluating liver disease. Each has strengths and limitations depending on the clinical context. Understanding when to use which score helps clinicians make better-informed decisions.
| Feature | Child-Pugh | MELD | ALBI |
|---|---|---|---|
| Parameters | 5 (lab + clinical) | 3 (lab only) | 2 (lab only) |
| Score Type | Categorical (A/B/C) | Continuous (6-40) | Continuous |
| Subjective Elements | Yes (ascites, encephalopathy) | No | No |
| Primary Use | Prognosis, surgical risk | Transplant allocation | Hepatocellular carcinoma |
| Limitations | Subjective components, ceiling effect | Does not include ascites/encephalopathy | Limited validation for cirrhosis |
The MELD score (Model for End-Stage Liver Disease) uses bilirubin, INR, and serum creatinine to produce a continuous score. It was adopted in 2002 for liver transplant organ allocation in the United States. The ALBI (Albumin-Bilirubin) score uses only albumin and bilirubin to assess liver function and is increasingly used in patients with hepatocellular carcinoma. Unlike the Child-Pugh score, neither MELD nor ALBI includes subjective clinical assessments, which can be both a strength (more reproducible) and a weakness (missing important clinical information).
The Child-Pugh score is essential for evaluating whether a patient with cirrhosis can safely undergo elective or emergency surgery. Class A patients tolerate most procedures well, while Class C patients face very high perioperative mortality.
Although MELD has replaced Child-Pugh for organ allocation priority, the Child-Pugh class remains part of the overall transplant workup. Class B and C patients are generally considered transplant candidates when other criteria are met.
Many pharmaceutical drug labels reference the Child-Pugh classification for hepatic dosing adjustments. Drugs metabolized by the liver often require reduced doses or are contraindicated in Class B or C patients to avoid toxicity.
Serial Child-Pugh scores help track disease progression or improvement over time. A patient whose score worsens from Class A to Class B may need closer monitoring or escalation of care, while improvement may indicate effective treatment.
The Child-Pugh score should be calculated using laboratory values obtained within the past few days. Older values may not reflect the patient's current liver function, especially if there has been a recent acute event such as infection or bleeding.
Patients on diuretics may have controlled ascites that would otherwise be moderate to severe. Consider the degree of ascites both with and without treatment when assigning points. A patient requiring high-dose diuretics to remain ascites-free is not the same as a patient who has never had ascites.
The Child-Pugh score uses INR (International Normalized Ratio), not raw prothrombin time in seconds. Some older references use PT cutoffs of less than 4 seconds prolonged, 4-6 seconds, and greater than 6 seconds. Use the INR-based criteria for consistency and accuracy.
Hepatic encephalopathy grading (especially the distinction between Grade 0 and Grade 1) can vary between clinicians. Minimal or subclinical encephalopathy may require specialized testing. Be consistent in your grading approach and document the clinical findings used.
The Child-Pugh score is one tool among many. It does not account for renal function, portal hypertension severity, or nutritional status. Always interpret the score alongside the full clinical picture, including imaging, other lab results, and the patient's overall condition.
The Child-Pugh score is a clinical scoring system used to assess the severity of chronic liver disease, particularly cirrhosis. It assigns points (1 to 3) across five parameters: total bilirubin, serum albumin, INR (prothrombin time), ascites, and hepatic encephalopathy. The total score ranges from 5 to 15 and classifies patients into Class A, B, or C.
Class A (5-6 points) indicates well-compensated cirrhosis with good liver function and excellent prognosis. Class B (7-9 points) indicates significant functional compromise with moderate liver impairment. Class C (10-15 points) indicates decompensated cirrhosis with severe liver dysfunction and the poorest prognosis.
The five parameters are total bilirubin (mg/dL), serum albumin (g/dL), INR or prothrombin time, presence and severity of ascites (fluid in the abdomen), and grade of hepatic encephalopathy (brain dysfunction due to liver failure). Each parameter is scored 1, 2, or 3 points.
The Child-Pugh score uses five clinical and laboratory parameters and classifies patients into three classes. The MELD (Model for End-Stage Liver Disease) score uses three laboratory values (bilirubin, INR, creatinine) to produce a continuous numerical score from 6 to 40. MELD is primarily used for organ transplant allocation, while Child-Pugh is more commonly used for assessing surgical risk and overall prognosis.
Total bilirubin is scored as follows: less than 2 mg/dL receives 1 point, 2 to 3 mg/dL receives 2 points, and greater than 3 mg/dL receives 3 points. Elevated bilirubin indicates the liver is not effectively processing and excreting bile pigments, which is a sign of impaired liver function.
Hepatic encephalopathy is a decline in brain function caused by severe liver disease. When the liver cannot remove toxins (especially ammonia) from the blood, these toxins accumulate and affect the brain. Symptoms range from mild confusion and sleep disturbance (Grade 1-2) to severe disorientation and coma (Grade 3-4). It is one of the five parameters in the Child-Pugh score.
Yes, the Child-Pugh score is widely used to estimate surgical risk in patients with cirrhosis. Class A patients generally tolerate surgery well with perioperative mortality under 10%. Class B patients have moderate risk with mortality around 30%. Class C patients have very high surgical risk with perioperative mortality exceeding 80%, and elective surgery is generally avoided.
Ascites is the accumulation of fluid in the peritoneal cavity (abdomen), a common complication of cirrhosis caused by portal hypertension and low albumin levels. In the Child-Pugh scoring system, no ascites receives 1 point, mild or diet-controlled ascites receives 2 points, and moderate to severe ascites that is poorly controlled receives 3 points.
Serum albumin is a protein produced by the liver. Low albumin levels indicate impaired liver synthetic function. In the Child-Pugh score, albumin greater than 3.5 g/dL receives 1 point, 2.8 to 3.5 g/dL receives 2 points, and less than 2.8 g/dL receives 3 points. Albumin levels also affect fluid balance and can contribute to ascites formation.
The Child-Pugh score is used as part of the overall evaluation of patients with chronic liver disease but is not the primary tool for transplant organ allocation in most countries. The MELD score is the standard for prioritizing transplant candidates in the United States and many other nations because it provides a continuous scale. However, Child-Pugh Class C status helps identify patients who may benefit from transplant referral.
This Child-Pugh score calculator is provided for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. The Child-Pugh score should be interpreted by qualified healthcare professionals in the context of the patient's complete clinical picture. Always consult a physician or other qualified health provider with any questions regarding a medical condition. Do not disregard professional medical advice or delay seeking it based on information from this calculator.