𧬠Child-Pugh Liver Score
Cirrhosis severity: class A, B, or C with survival estimates.
Educational only. Liver prognosis and transplant decisions belong to the hepatology team.
The Child-Pugh score has graded cirrhosis severity since the 1970s, and surgeons still quote it before operating on liver patients. Five measures, bilirubin, albumin, INR, ascites, and encephalopathy, each scored 1 to 3, sum to a class: A (5-6, compensated), B (7-9), or C (10-15, decompensated). This calculator scores all five with the standard cutoffs and shows the approximate survival for each class.
How to Use This Calculator
Enter the three lab values and grade the two clinical findings. The class appears instantly.
Enter bilirubin (mg/dL), albumin (g/dL), and INR from recent labs.
Grade ascites (none, slight/moderate, severe) and encephalopathy (none, grade 1-2, grade 3-4) from the clinical exam.
Read the class: A is compensated cirrhosis, B significant dysfunction, C decompensated. Discuss with the hepatology team.
The Five Components
Each component measures a liver job: bilirubin clearance, albumin synthesis, clotting factor production (INR), portal hypertension consequences (ascites), and detoxification (encephalopathy). Child and Turcotte designed it in 1964 to predict surgical mortality in variceal bleeding; Pugh replaced the original nutritional criterion with INR in 1973, and the modification stuck. The survival figures are the classic approximations every trainee memorizes; individual prognosis varies with cause, age, and treatment.
Two components are subjective, which is the score's known weakness: grading ascites and encephalopathy varies between examiners, and diuretics or lactulose can mask both. That subjectivity is one reason transplant allocation moved to MELD, a purely lab-based score. Child-Pugh remains the bedside language for describing where a cirrhosis patient stands, and surgeons still use class C as a strong caution against elective procedures.
Worked Example
Bilirubin 2.5 (2 points), albumin 3.0 (2), INR 1.5 (2), moderate ascites (2), grade 1-2 encephalopathy (2): total 10, class C, approximately 45 percent 1-year survival. Improve albumin to 3.8 with nutrition and clear the encephalopathy with lactulose: 2 + 1 + 2 + 2 + 1 = 8, class B, about 80 percent. The two-point swing from reversible factors shows why the score is reassessed after treatment: it measures current state, not destiny. But note the subjectivity trap: the same patient could score 9 or 11 depending on who grades the ascites.
Child-Pugh vs MELD
MELD (Model for End-Stage Liver Disease) uses bilirubin, INR, creatinine, and sodium in a logarithmic formula to predict 90-day mortality, and it allocates liver transplants in the US because it is objective and continuous. Child-Pugh remains better at describing the clinical picture: a single letter conveys compensation status instantly. In practice, hepatologists use both: MELD for the list, Child-Pugh for the conversation. Our Charlson Index calculator adds the comorbidity context that neither liver score captures.
For patients and families, class C is the point where transplant evaluation usually enters the conversation, and where elective surgery becomes dangerous. Class A patients often live for years with monitoring and cause-directed treatment (alcohol abstinence, hepatitis treatment, weight loss for fatty liver). The class is a snapshot: treating the underlying cause, managing complications, and avoiding alcohol and NSAIDs can genuinely move patients between classes.
What Moves the Score
Albumin rises with nutrition and falls with inflammation; it is slow to change. Bilirubin and INR reflect current liver function and respond to treating the cause. Ascites improves with sodium restriction, diuretics, and large-volume paracentesis when needed. Encephalopathy improves dramatically with lactulose and rifaximin, plus treating triggers like infection, bleeding, or constipation. Alcohol abstinence is the single highest-impact move in alcohol-related disease. None of this replaces hepatology care, but understanding which points are movable turns a frightening letter grade into a treatment checklist.
Related Calculators
Keep exploring: try our Maddrey's discriminant function and BMI calculator for the next piece of the picture.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the Child-Pugh score?
A 5-component cirrhosis severity score (bilirubin, albumin, INR, ascites, encephalopathy, each 1-3 points) totaling 5-15, grouped into classes A (5-6), B (7-9), and C (10-15). Developed from Child-Turcotte (1964) and modified by Pugh (1973).
What do Child-Pugh classes mean?
Class A: compensated cirrhosis, ~100% 1-year survival. Class B: significant dysfunction, ~80%. Class C: decompensated cirrhosis, ~45%. Higher classes mean higher surgical risk and usually trigger transplant evaluation.
How is Child-Pugh calculated?
Score each of the 5 components 1-3 using the standard cutoffs and sum them. This calculator applies the cutoffs automatically from your lab values and clinical grades.
What is the difference between Child-Pugh and MELD?
Child-Pugh mixes labs with clinical judgment (ascites, encephalopathy grades) and describes compensation status in classes. MELD is purely lab-based (bilirubin, INR, creatinine, sodium) and predicts 90-day mortality; it allocates liver transplants in the US. Clinicians use both.
Can Child-Pugh class improve?
Yes. Treating the underlying cause, improving nutrition (albumin), controlling ascites and encephalopathy, and alcohol abstinence can move patients from C to B or B to A. The score measures current state, not destiny.
What is a bad Child-Pugh score?
Class C (10-15) indicates decompensated cirrhosis with high short-term mortality (~45% 1-year survival) and high surgical risk. It usually prompts transplant evaluation and avoidance of elective procedures.
Why is ascites grading subjective?
Because "slight" versus "severe" ascites is a bedside judgment call, and diuretics can mask it. This subjectivity is Child-Pugh's known weakness versus MELD's pure objectivity. When in doubt, the treating team's grading stands.
Does Child-Pugh predict transplant need?
Indirectly: class B and especially class C generally warrant transplant evaluation, but actual organ allocation uses MELD. Child-Pugh frames the conversation; MELD runs the list.
What is hepatic encephalopathy?
Brain dysfunction from liver failure to clear toxins (especially ammonia): confusion, sleep reversal, asterixis (flapping tremor), progressing to coma. Graded 1-4 clinically; grades 1-2 score 2 points, 3-4 score 3 in Child-Pugh. Lactulose and rifaximin are mainstays of treatment.
Who should calculate Child-Pugh?
The hepatology or surgical team, from real labs and exam. This calculator is for understanding what the class means and which components drive it. If you have cirrhosis and do not know your class, ask at the next visit.