Child-Pugh Calculator — Cirrhosis Severity

Child-Pugh Score

Liver Cirrhosis Severity Assessment

Total Bilirubin *

< 2 mg/dL (1 point) 2–3 mg/dL (2 points) > 3 mg/dL (3 points)

Serum Albumin *

> 3.5 g/dL (1 point) 2.8–3.5 g/dL (2 points) < 2.8 g/dL (3 points)

INR (International Normalized Ratio) *

< 1.7 (1 point) 1.7–2.3 (2 points) > 2.3 (3 points)

Ascites *

Absent (1 point) Mild to moderate — controlled with diuretics (2 points) Severe — refractory or difficult to control (3 points)

Hepatic Encephalopathy *

Absent (1 point) Grade I–II — minimal to mild (2 points) Grade III–IV — moderate to severe (3 points)

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, MELD-Na has replaced Child-Pugh for organ allocation by UNOS/OPTN due to its use of objective laboratory variables only — however, the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) recognize Child-Pugh as a standard tool for surgical risk stratification in cirrhotic patients, and it remains widely used in US clinical practice for perioperative assessment and staging of chronic liver disease.

⚠️ Important limitations

Subjective components: Grading of ascites and encephalopathy depends on clinical examination and is subject to inter-observer variability — a recognized 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-Na for liver transplant organ allocation by UNOS/OPTN and other transplant systems internationally.

⚠️ 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 ↗

Calculamedica

Child-Pugh Score

Result

Interpretation

⚠️ Important limitations