Child-Pugh score calculator

The Child-Pugh score grades the severity of cirrhosis. It is widely used for prognosis, surgical risk and drug dosing in liver disease.

What goes into the Child-Pugh score

Total bilirubin: < 2 mg/dL (1); 2–3 mg/dL (2); > 3 mg/dL (3)
Albumin: > 3.5 g/dL (1); 2.8–3.5 g/dL (2); < 2.8 g/dL (3)
INR: < 1.7 (1); 1.7–2.3 (2); > 2.3 (3)
Ascites: None (1); Mild or controlled with diuretics (2); Moderate to severe or refractory (3)
Hepatic encephalopathy: None (1); Grade 1–2 or controlled with medication (2); Grade 3–4 or refractory (3)

How to interpret the result

5–6: class A (well compensated)
7–9: class B (significant functional compromise)
10–15: class C (decompensated)

Clinical pearls

Drug labels often give dosing by Child-Pugh class.
Ascites and encephalopathy are subjective; MELD is more objective and preferred for transplant listing.
Class C cirrhosis carries high perioperative mortality; avoid elective surgery.

Evidence

Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-649.

Related workups

Decompensated cirrhosis (ascites, SBP, hepatic encephalopathy)Alcohol-associated hepatitis Upper GI bleed

Related calculators

MELD 3.0 and MELD-Na Maddrey discriminant function All calculators

For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.