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Child-Pugh Score Calculator (Cirrhosis Severity)

Child-Pugh class A, B or C from bilirubin, albumin, INR, ascites and encephalopathy — one- and two-year survival, operative mortality and drug-dosing implications in cirrhosis.

Total bilirubin

Serum albumin

INR

Ascites

Hepatic encephalopathy

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How it works

Bilirubin < 34 / 34–50 / > 50 µmol/L → 1/2/3; albumin > 35 / 28–35 / < 28 g/L → 1/2/3; INR < 1.7 / 1.7–2.3 / > 2.3 → 1/2/3; ascites and encephalopathy none/mild/severe → 1/2/3. A 5–6, B 7–9, C 10–15

Child and Turcotte devised the score in 1964 to predict who would survive shunt surgery for portal hypertension; Pugh replaced nutritional status with prothrombin time in 1973, and INR has since replaced PT. Two laboratory values reflect synthetic function (albumin, INR), one reflects excretion (bilirubin), and two clinical features reflect portal hypertension and its consequences (ascites, encephalopathy). Class A patients have compensated cirrhosis and near-normal life expectancy over a year; class C patients face roughly 45% one-year survival and prohibitive surgical risk. The score still guides drug dosing (many labels specify Child-Pugh B and C adjustments) and surgical candidacy, though MELD has replaced it for transplant allocation because it avoids the subjective ascites and encephalopathy grades.

Worked example

Bilirubin 45 (2), albumin 30 (2), INR 1.9 (2), mild ascites (2), no encephalopathy (1): score 9 — class B, about 80% one-year survival.

Frequently asked questions

Child-Pugh or MELD?

MELD (bilirubin, INR, creatinine, sodium) is objective and used for transplant listing; Child-Pugh remains better known for surgical risk and drug labelling. Report both.

What about primary biliary cholangitis?

For cholestatic diseases the bilirubin thresholds are raised (< 68 / 68–170 / > 170 µmol/L) because bilirubin rises out of proportion to synthetic failure.

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Clinical decision tool for education and for use by trained clinicians alongside judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.