Child-Pugh Score
Liver Cirrhosis Severity Assessment
Result
Total Bilirubin:
Serum Albumin:
INR:
Ascites:
Encephalopathy:
Interpretation
The Child-Pugh Score assesses liver cirrhosis severity based on five clinical and laboratory parameters. The total score ranges from 5 to 15 points, classifying patients into three classes (A, B and C) with distinct prognostic and therapeutic implications.
| Score | Class | Severity | 1-year survival | 2-year survival | Operative mortality* |
|---|---|---|---|---|---|
| 5–6 | Class A | Well-compensated disease | 100% | 85% | ~10% |
| 7–9 | Class B | Significant functional impairment | 81% | 57% | ~30% |
| 10–15 | Class C | Decompensated disease | 45% | 35% | ~80% |
* Estimated operative mortality for elective abdominal surgery in cirrhotic patients.
† Survival data based on meta-analysis (Cholongitas et al., 2005). Some sources cite slightly different values for Class B (80%/60%), reflecting variability between cohorts.
Clinical context: The Child-Pugh Score is widely used for pre-operative assessment, risk stratification, and prognosis of cirrhosis. Class C patients are priority candidates for liver transplantation. The score was originally developed by Child and Turcotte (1964) and modified by Pugh et al. (1973), who replaced nutritional status with prothrombin time (now expressed as INR). In the US and many international centres, MELD has replaced Child-Pugh for organ allocation due to its use of objective laboratory variables only — however, Child-Pugh remains widely used for surgical risk assessment and clinical staging of cirrhosis. In the UK, NHS Blood and Transplant (NHSBT) uses UKELD for liver transplant allocation rather than Child-Pugh; Child-Pugh nonetheless remains widely used across the UK and internationally for surgical risk stratification and clinical staging of cirrhosis.
⚠️ Important limitations
- Subjective components: Grading of ascites and encephalopathy depends on clinical examination and is subject to inter-observer variability — a recognised limitation of the score in the literature.
- Indicated only for chronic liver disease: The score was developed and validated in patients with cirrhosis. It should not be applied in acute or fulminant hepatic failure, where other scoring systems are more appropriate (e.g. King's College Criteria).
- Replaced by MELD for transplant allocation: Due to its subjective parameters and only 10 scoring levels — limiting differentiation between patients — Child-Pugh has been replaced by MELD for liver transplant organ allocation in many countries.
⚠️ Note: This calculator is an educational support tool. The Child-Pugh Score does not replace a complete clinical assessment by the responsible medical team, particularly for decisions relating to liver transplantation and surgical management of patients with cirrhosis.
References
- 1. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. "Transection of the oesophagus for bleeding oesophageal varices." Br J Surg. 1973;60(8):646–649. PubMed ↗
- 2. Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs AK. "Systematic review: The model for end-stage liver disease — should it replace Child–Pugh's classification for assessing prognosis in cirrhosis?" Aliment Pharmacol Ther. 2005;22(11–12):1079–1089. PubMed ↗