About the Child-Pugh Score Calculator
The Child-Pugh score (also called Child-Turcotte-Pugh) grades the severity of chronic liver disease, mainly cirrhosis. It combines three blood tests — total bilirubin, serum albumin and the INR — with two clinical findings, ascites and hepatic encephalopathy. Each is scored 1 to 3 points, giving a total of 5 to 15 that places the patient in class A (5–6), B (7–9) or C (10–15).
Originally described by Child and Turcotte in 1964 and modified by Pugh and colleagues in 1973 (who replaced nutritional status with prothrombin time) to predict outcomes after surgery for bleeding oesophageal varices, it is still used to estimate prognosis, judge surgical risk and guide drug labelling for patients with hepatic impairment. For primary biliary cholangitis and primary sclerosing cholangitis, a modified bilirubin scale is used because bilirubin runs higher in cholestatic disease.
Enter results in US units (mg/dL, g/dL) or SI units (µmol/L, g/L). The ascites and encephalopathy grades are clinical judgements, which makes the score partly subjective; for transplant prioritisation the MELD score is preferred. The survival figures shown are commonly quoted historical estimates, not individual predictions.
With the default inputs, the child-pugh score is 7 / 15. Change any value above to recalculate instantly.
How to use the child-pugh score calculator
- 1Choose US or SI units to match the lab report.
- 2Enter total bilirubin, serum albumin and the INR.
- 3Grade ascites and hepatic encephalopathy from the clinical assessment.
- 4Turn on the cholestatic option for PBC or PSC to use the modified bilirubin bands.
- 5Read the total score, the class and the historical survival estimates.
Formula and method
Bilirubin scores 1 below 2 mg/dL (34 µmol/L), 2 for 2–3 mg/dL (34–50 µmol/L) and 3 above 3 mg/dL (50 µmol/L); in PBC or PSC the bands are below 4, 4–10 and above 10 mg/dL. Albumin scores 1 above 3.5 g/dL (35 g/L), 2 for 2.8–3.5 g/dL and 3 below 2.8 g/dL. INR scores 1 below 1.7, 2 for 1.7–2.3 and 3 above 2.3 (Pugh’s 1973 version used prothrombin time prolonged by less than 4, 4–6 or more than 6 seconds; the INR bands are the accepted modern equivalent).
Ascites scores 1 if absent, 2 if slight or controlled with diuretics and 3 if moderate to severe or refractory. Encephalopathy scores 1 if absent, 2 for grade 1–2 (or controlled with medication) and 3 for grade 3–4. The five scores are added, giving 5–15. Commonly quoted historical survival is about 100% at 1 year and 85% at 2 years for class A, 80% and 60% for class B, and 45% and 35% for class C.
- INR
- International normalised ratio (the 1973 version used prothrombin time prolongation)
- PBC / PSC
- Primary biliary cholangitis / primary sclerosing cholangitis
Worked examples
Class B cirrhosis with diuretic-controlled ascites
Bilirubin 1.5 mg/dL (1) + albumin 3.2 g/dL (2) + INR 1.4 (1) + slight ascites (2) + no encephalopathy (1) = 7 points, the bottom of class B.
Compensated cirrhosis
Every parameter is in its best band, giving the minimum score of 5 — Child-Pugh class A.
Decompensated cirrhosis
Bilirubin 4.2 (3) + albumin 2.5 (3) + INR 2.5 (3) + moderate ascites (3) + grade 1–2 encephalopathy (2) = 14 points, class C.
SI units
Bilirubin 40 µmol/L (2) + albumin 30 g/L (2) + INR 1.8 (2) + no ascites (1) + no encephalopathy (1) = 8 points, class B.
Frequently asked questions
What do Child-Pugh classes A, B and C mean?+
Class A (5–6 points) is well-compensated cirrhosis, class B (7–9) indicates significant functional compromise and class C (10–15) is decompensated disease. Prognosis worsens markedly from A to C.
What is the difference between Child-Pugh and MELD?+
Child-Pugh uses five items including two subjective clinical grades and caps each item at 3 points. MELD uses only objective lab values (bilirubin, INR, creatinine and, in MELD-Na, sodium) as continuous variables, which is why MELD is used for liver transplant allocation.
Why is there a different bilirubin scale for PBC and PSC?+
In cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis, bilirubin rises earlier and higher relative to liver function, so higher cut-offs (4 and 10 mg/dL) are used to avoid overstating severity.
How do I grade hepatic encephalopathy?+
Grades follow the West Haven criteria: grade 1 is mild confusion or altered sleep, grade 2 lethargy and disorientation, grade 3 somnolence with marked confusion and grade 4 coma. Grades 1–2 score 2 points and grades 3–4 score 3 points.
Is the Child-Pugh score used for medicine dosing?+
Drug regulators often describe hepatic impairment as Child-Pugh A, B or C in product labelling. Any dose decisions must come from the product information and a pharmacist or prescriber; this calculator does not provide dosing advice.
For healthcare professionals and education only. This calculator implements a published formula or score but is not a diagnosis and does not replace clinical judgment. Verify inputs and results against the original source before using them in patient care.