Child Pugh Score Calculator

Child-Pugh scores the functional severity of chronic liver disease across five domains, each graded 1 to 3 for a total of 5 to 15: bilirubin (synthetic / excretory function), albumin (long-term synthetic reserve), INR (acute synthetic function and clotting factor production), ascites (portal hypertension and renal handling of sodium), and hepatic encephalopathy (clearance of nitrogenous waste). Two of the five components, ascites and encephalopathy, are clinical judgments rather than lab values, which is what makes Child-Pugh quick at the bedside but also subjective. Total 5 to 6 is Class A (compensated), 7 to 9 is Class B (significant compromise), and 10 to 15 is Class C (decompensated).

The two-year survival figures most often cited in hepatology references trace back to the original 1973 Pugh et al. cohort of 38 cirrhotic patients undergoing esophageal transection for variceal bleeding: roughly 85 percent for Class A, 57 percent for Class B, and 35 percent for Class C. One-year survival in the same cohort was about 100 percent, 80 percent, and 45 percent. Modern cohorts on best medical therapy do better in Class A and B and somewhat better in Class C, but the rank order and the broad strokes hold. The numbers should be treated as a prognostic guide for shared decision making, not as a precise individual prediction.

MELD-Na is a continuous, lab-only score based on bilirubin, creatinine, INR, and sodium. US liver allocation used MELD-Na from 2016 until July 2023, when OPTN replaced it with MELD 3.0. Child-Pugh is a 5-to-15 categorical score that also includes the clinical assessments of ascites and encephalopathy. Use the current OPTN MELD 3.0 policy for transplant-priority questions. Child-Pugh remains a general severity descriptor, but neither score replaces a transplant or hepatology assessment.

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are cholestatic diseases in which bilirubin can rise substantially from impaired biliary excretion without the same prognostic weight that the same bilirubin would carry in a patient with hepatocellular cirrhosis. To avoid systematically overscoring PBC and PSC patients, the modified Child-Pugh uses widened bilirubin cut-offs: under 4 mg/dL scores 1 point, 4 to 10 mg/dL scores 2 points, and over 10 mg/dL scores 3 points. The other four components (albumin, INR, ascites, encephalopathy) are unchanged. Toggle the modified thresholds in the calculator when scoring a known PBC or PSC patient.

Older surgical cohorts found progressively higher perioperative mortality from Class A through Class C, but those historical percentages are not precise predictions for an individual. Child-Pugh alone cannot determine surgical candidacy. Procedure type, urgency, portal hypertension, kidney function, frailty, comorbidities, and current liver status all matter. A hepatology, anesthesia, and surgical team should use a current validated perioperative model and specialist assessment for the actual decision.