- Enter the patient's total bilirubin (mg/dL), serum albumin (g/dL), and INR. Each is binned to 1–3 points automatically.
- Select the grade of ascites (none / mild / moderate–severe) and hepatic encephalopathy (none / grade 1–2 / grade 3–4).
- The total score (5–15) and Child-Pugh class appear once all five parameters are entered.
- Class A (5–6) = well-compensated; Class B (7–9) = significant functional compromise; Class C (10–15) = decompensated cirrhosis.
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When to Use
Use the Child-Pugh score in any patient with established cirrhosis to grade the severity of hepatic dysfunction and stratify risk. It is the classic bedside grade for cirrhosis: it predicts short- and medium-term survival, frames the risk of non-transplant surgery and anesthesia, informs variceal-bleed and TIPS decisions, and is the reference scale that many drug labels use to define hepatic-impairment dosing (mild = Class A, moderate = Class B, severe = Class C).
Appropriate population
Adults with known cirrhosis of any etiology. Particularly useful for perioperative and pre-procedural risk assessment, for selecting hepatic-impairment drug dosing, and as a quick prognostic communication tool. It complements MELD-Na, which is the objective, lab-only score used for transplant allocation.
When NOT to rely on it
Two of the five parameters — ascites and encephalopathy — are subjective and depend on clinical grading and treatment response, which limits reproducibility. The score also caps at 15, so it discriminates poorly among the sickest patients. For transplant-list prioritization use MELD-Na. Bilirubin thresholds differ for predominantly cholestatic disease (e.g., PBC); the calculator uses the standard thresholds.
Pearls & Pitfalls
Five parameters, three classes
Each of the five parameters scores 1–3 points, for a total of 5–15. Class A = 5–6 (well-compensated, ~100% 1-year survival in published series), Class B = 7–9 (significant functional compromise, ~80% 1-year), Class C = 10–15 (decompensated, ~45% 1-year). The class — not just the number — drives most clinical decisions.
Nephrology relevance
Cirrhosis severity is tightly linked to renal outcomes: advanced Child-Pugh class predisposes to hepatorenal syndrome and AKI in cirrhosis, and the interplay of renally-cleared drugs with hepatic clearance matters when both organs are failing. Many drug labels give hepatic-impairment guidance keyed to Child-Pugh class, so the score directly shapes dosing alongside eGFR-based renal adjustments.
Pitfalls
(1) Ascites and encephalopathy are subjective — score them by current clinical status, recognizing that diuretic-controlled ascites or medically-controlled encephalopathy still scores 2 points, not 1. (2) Use INR (the standard parameter), not raw PT seconds. (3) The bilirubin thresholds shown are for non-cholestatic disease. (4) Child-Pugh and MELD-Na answer different questions: Child-Pugh grades severity and guides bedside/perioperative and dosing decisions, while MELD-Na is the objective allocation score.
Why Use It
The Child-Pugh score remains the most widely recognized bedside grade of cirrhosis severity. It converts five readily available parameters into a single class that communicates prognosis, frames the risk of surgery and anesthesia in patients with liver disease, informs variceal-bleed and TIPS decisions, and — uniquely among liver scores — is the reference scale embedded in drug labels for hepatic-impairment dosing. While MELD-Na has supplanted it for transplant allocation because it is fully objective and lab-based, Child-Pugh persists precisely because it is fast, intuitive, and directly actionable at the bedside and in pharmacotherapy decisions, including the renally-cleared and hepatically-metabolized drugs that matter so much in patients with combined hepatic and kidney dysfunction.
Child-Pugh Score — Cirrhosis Severity
Enter the three lab values and select the ascites and encephalopathy grades. Each parameter is binned to 1–3 points; the total score and Child-Pugh class (A/B/C) with prognosis appear once all five are entered.
⚕ Pugh RN, et al. Br J Surg. 1973;60(8):646–649. The Child-Pugh score grades cirrhosis severity; two parameters (ascites, encephalopathy) are subjective. Survival figures are published estimates and vary by etiology and era. Use MELD-Na for transplant allocation. For licensed clinicians; not a substitute for individualized assessment.
Next Steps
Use the Child-Pugh class to communicate prognosis and direct the next move.
- Class A (5–6): well-compensated cirrhosis (~100% 1-yr, ~85% 2-yr survival in published series). Generally tolerates surgery and standard dosing; continue surveillance for varices and HCC and manage the underlying liver disease.
- Class B (7–9): significant functional compromise (~80% 1-yr, ~60% 2-yr). Elevated perioperative risk; review medications for hepatic-impairment dosing; intensify management of ascites/encephalopathy and consider transplant evaluation.
- Class C (10–15): decompensated cirrhosis (~45% 1-yr, ~35% 2-yr). High surgical and anesthetic risk; prioritize transplant evaluation, treat complications aggressively, and apply severe-hepatic-impairment drug dosing.
- For transplant-list prioritization, calculate the MELD-Na score. When AKI complicates cirrhosis, assess FENa / FEUrea and consider hepatorenal syndrome.
Evidence & References
Scoring (5 parameters, 1–3 points each)
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin (mg/dL) | <2 | 2–3 | >3 |
| Serum albumin (g/dL) | >3.5 | 2.8–3.5 | <2.8 |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | None | Mild / controlled | Moderate–severe |
| Encephalopathy | None | Grade 1–2 | Grade 3–4 |
Class & Prognosis
| Total | Class | Severity | ~1-yr / 2-yr survival |
|---|---|---|---|
| 5–6 | A | Well-compensated | ~100% / ~85% |
| 7–9 | B | Significant compromise | ~80% / ~60% |
| 10–15 | C | Decompensated | ~45% / ~35% |
Survival figures are published estimates and vary by etiology, era, and complication burden. The score uses the standard (non-cholestatic) bilirubin thresholds and INR rather than raw PT seconds.
References
- 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.
- Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. Philadelphia: Saunders; 1964:50–64.
- D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217–231.
