Hepatology
Child-Pugh Cirrhosis Score
The Child-Pugh score stratifies cirrhosis severity and correlates with survival and transplant prioritization. Select the findings that best match your patient to calculate the total score and class.
Hepatic encephalopathy
Ascites
Total bilirubin (mg/dL)
Serum albumin (g/dL)
INR / PT prolongation
Component points
- encephalopathy1
- ascites1
- bilirubin1
- albumin1
- inr1
Total Child-Pugh score
5
Range 5 – 15
Compensated cirrhosis with relatively good short-term prognosis. Continue surveillance and address complications early.
Consider MELD-Na for transplant allocation and monitor complications (varices, HRS, SBP).
How to Use This Calculator
Assess clinical features
Grade ascites with ultrasound and therapeutic response; evaluate encephalopathy using West Haven criteria.
Use recent labs
Enter bilirubin, albumin, and INR/PT from the past 24 hours, preferably after stabilization.
Interpret class and plan management
Higher classes imply increased mortality and priority for transplant evaluation and monitoring for complications.
Formula
- Score each domain 1 (A), 2 (B), or 3 (C) based on severity.
- Total Child-Pugh score = Sum of the five domain scores (range 5–15).
- Class A: 5–6 points • Class B: 7–9 points • Class C: 10–15 points.
Full Description
The Child-Pugh score (Child-Turcotte-Pugh) is a traditional cirrhosis staging system using clinical (ascites, encephalopathy) and biochemical markers (bilirubin, albumin, INR/PT). It predicts 1-year survival and guides decisions regarding surgery, TIPS, and transplant eligibility.
Despite its qualitative components, Child-Pugh remains widely used alongside MELD-Na. Sedation, diuretics, or TIPS placement can affect the parameters; document these factors when interpreting results.
Frequently Asked Questions
Does Child-Pugh replace MELD score?
No. MELD-Na is used for transplant allocation. Child-Pugh complements MELD by incorporating encephalopathy and ascites.
How do diuretics impact scoring?
Ascites classification should consider diuretic response. Refractory ascites counts as Class C regardless of diuretic regimen.
Can I apply Child-Pugh to acute liver failure?
No. It is designed for chronic liver disease. Use the King’s College criteria or MELD in acute liver failure.
What about patients on anticoagulation?
INR may be artificially elevated. Consider alternative measures (e.g., factor V) and note anticoagulant use when interpreting the score.