What the Child-Pugh score measures
The Child-Pugh score grades the severity of cirrhosis. It was proposed by Child and Turcotte in 1964 to predict surgical risk and modified by Pugh in 1973. It remains one of the most widely used tools in liver disease, in particular for drug dosing.
The five criteria
| Criterion | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin | < 2 mg/dL | 2–3 mg/dL | > 3 mg/dL |
| Albumin | > 3.5 g/dL | 2.8–3.5 g/dL | < 2.8 g/dL |
| INR | < 1.7 | 1.7–2.3 | > 2.3 |
| Ascites | None | Mild or controlled | Moderate to severe |
| Encephalopathy | None | Grade 1–2 | Grade 3–4 |
For primary biliary cholangitis and primary sclerosing cholangitis, higher bilirubin cutoffs (4 and 10 mg/dL) are sometimes used.
Worked example
A patient with bilirubin 1.5 mg/dL (1), albumin 3.1 g/dL (2), INR 1.4 (1), mild ascites controlled with diuretics (2) and no encephalopathy (1) scores 7: Child-Pugh class B.
Classes and survival
| Class | Points | 1-year survival | 2-year survival |
|---|---|---|---|
| A | 5–6 | about 100% | about 85% |
| B | 7–9 | about 80% | about 60% |
| C | 10–15 | about 45% | about 35% |
These figures come from older cohorts; modern treatment has improved outcomes, especially in class A.
How it is used
- Drug dosing: FDA labels often give specific advice for Child-Pugh class B and C, or advise against use.
- Surgery: perioperative mortality for abdominal surgery is roughly 10% in class A, 30% in class B and 70% to 80% in class C in classic series.
- Liver cancer: the Barcelona Clinic Liver Cancer staging system uses liver function, historically by Child-Pugh class, to choose treatment.
Child-Pugh and MELD
The MELD score uses only lab values and is the basis for transplant allocation in the US. Child-Pugh includes the clinical assessment of ascites and encephalopathy, which makes it more subjective but captures complications that matter to patients.
Improving the score
Treating the cause, such as stopping alcohol, curing hepatitis C or controlling hepatitis B, and managing ascites and encephalopathy can improve the class over months.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.