Child-Pugh Score Calculator

Child-Pugh Score Calculator for Gastroenterology. Totals map to three classes: Class A (5-6 points) is well-compensated disease with about 100% and 85% one- and two-year survival; Class B (7-9 points) is significant functional compromise with roughly 80% and 60% survival; Class C (10-15 points) is decompensated disease with approximately 45% and 35% survival. The class drives concrete decisions: Class A patients generally tolerate elective surgery, Class B requires caution and optimization, and Class C is a relative contraindication to elective non-transplant abdominal surgery given reported perioperative mortality that climbs steeply from Class A to C. Many drug labels also specify dose reductions or avoidance in Class B/C.

How this calculator works

The Child-Pugh score sums points across five variables of chronic liver disease severity: serum bilirubin, serum albumin, INR (originally prothrombin time), ascites, and hepatic encephalopathy. Each variable is scored 1, 2, or 3 points, giving a total of 5 to 15 points. The two clinical variables (ascites and encephalopathy) are graded by severity rather than measured, while the three laboratory variables use fixed cutoffs. Pugh's 1973 modification replaced the original nutritional-status item (from Child & Turcotte) with prothrombin time to improve reproducibility.

When to use this calculator

Use it to stratify chronic liver disease severity and estimate perioperative mortality before non-transplant surgery, to gauge candidacy and prognosis in cirrhosis, and for drug dosing decisions where labeling is stratified by Child-Pugh class. It is not a substitute for MELD/MELD-Na in liver transplant allocation, which UNOS/OPTN uses instead. Avoid applying it to acute liver failure, and interpret cautiously when bilirubin is driven by cholestasis (e.g., primary biliary cholangitis) or when albumin/INR are altered by non-hepatic factors such as anticoagulation, sepsis, or nephrotic-range proteinuria.

Inputs used

  • Bilirubin
  • Albumin
  • INR or prothrombin time
  • Ascites severity
  • Hepatic encephalopathy grade

Clinical interpretation

Totals map to three classes: Class A (5-6 points) is well-compensated disease with about 100% and 85% one- and two-year survival; Class B (7-9 points) is significant functional compromise with roughly 80% and 60% survival; Class C (10-15 points) is decompensated disease with approximately 45% and 35% survival. The class drives concrete decisions: Class A patients generally tolerate elective surgery, Class B requires caution and optimization, and Class C is a relative contraindication to elective non-transplant abdominal surgery given reported perioperative mortality that climbs steeply from Class A to C. Many drug labels also specify dose reductions or avoidance in Class B/C.

Worked example

A patient with bilirubin 3.5 mg/dL (2 pts), albumin 2.6 g/dL (3 pts), INR 1.9 (2 pts), moderate ascites controlled on diuretics (2 pts, grade 2), and no encephalopathy (1 pt) totals 10 points. This places the patient in Class C (10-15), corresponding to roughly 45% one-year survival and markedly elevated surgical mortality, arguing strongly against elective non-transplant surgery.

Limitations and safety notes

Two of the five variables (ascites and encephalopathy) are subjective and grader-dependent, and the fixed cutoffs create ceiling effects that fail to distinguish, for example, a bilirubin of 4 from 25 mg/dL once the 3-point threshold is crossed. It omits renal function and serum sodium, both powerful prognostic markers captured by MELD-Na. It performs poorly in cholestatic disease where bilirubin cutoffs were not designed, and albumin and INR can be confounded by infusions, malnutrition, or anticoagulation independent of hepatic synthetic function.

Frequently asked questions

What is the difference between the Child-Pugh score and the original Child-Turcotte classification?

Child and Turcotte's 1964 classification used nutritional status as one of its five criteria. Pugh's 1973 modification replaced that subjective nutrition item with prothrombin time (now INR), which is more objective and reproducible, producing the version used today.

Why has MELD largely replaced Child-Pugh for transplant allocation?

MELD (and MELD-Na) is a continuous, objective score using bilirubin, INR, creatinine, and sodium, avoiding the subjective ascites and encephalopathy grading and incorporating renal function and hyponatremia. UNOS/OPTN adopted MELD-based allocation because it better predicts short-term waitlist mortality and resists gaming.

Which grading scale is used for the ascites and encephalopathy components?

Ascites is scored as none (1), mild/diuretic-responsive (2), or moderate-to-severe/refractory (3). Encephalopathy is scored as none (1), grade 1-2 (2), or grade 3-4 (3) using the West Haven criteria.

Can Child-Pugh guide drug dosing?

Yes. Many drugs metabolized or cleared hepatically carry labeling stratified by Child-Pugh class, with dose reductions or contraindications in Class B and especially Class C. Always check the specific product label, as recommendations vary by agent.

Does the score work in acute liver failure?

No. Child-Pugh was derived and validated in chronic liver disease and cirrhosis. Acute liver failure has different kinetics and prognostic drivers; use dedicated tools such as the King's College Criteria instead.

References

  • Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-9. PMID: 4541913.
  • Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85. PMID: 4950264.
  • Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling SC, Nadim MK, Wong F, Kim WR. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. PMID: 33942342.

Editorial review and citation methodology

Reviewed by the Quick Medical Calculator Editorial Team. Last reviewed: March 21, 2026. The review checks calculator inputs, intended population, interpretation, limitations, and source alignment.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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