Hepatology
Child-Pugh Score
Severity and prognosis of chronic liver disease.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Child-Pugh score grades the severity of chronic liver disease and estimates prognosis and operative risk in cirrhosis. It combines two laboratory values — serum bilirubin and serum albumin, plus the prothrombin time or INR — with two clinical features: ascites and hepatic encephalopathy. Each of the five variables scores 1 to 3 according to severity, giving a total from 5 to 15. The total is grouped into three classes, A, B and C.
Interpreting the result
A total of 5–6 is Class A (well-compensated disease) with a good prognosis, 7–9 is Class B (significant functional compromise) and 10–15 is Class C (decompensated disease) with the poorest survival. The class informs prognosis, transplant assessment and the risk of surgery or procedures, with Class C patients tolerating intervention poorly. It reflects hepatic reserve, drawing on both objective tests and the clinical assessment of ascites and encephalopathy.
Worked example
A patient with mild ascites (2), no encephalopathy (1), a bilirubin in the intermediate range (2), a low albumin (3) and a moderately prolonged INR (2) scores 10, placing them in Class C — decompensated cirrhosis with a high operative risk.
Pearls / pitfalls
- Two components — ascites and encephalopathy — are graded clinically, introducing subjectivity that can shift the class.
- It assesses chronic liver disease severity; it is not designed for acute liver failure.
- MELD is generally preferred for transplant prioritisation, whereas Child-Pugh remains useful for prognosis and procedural risk.
- Albumin and clotting can be affected by factors other than liver disease, so interpret in the full clinical context.
Evidence & validation
The scoring system derives from the work of Child and Turcotte and was modified by Pugh and colleagues for grading bleeding risk in variceal surgery. It remains a long-established, validated measure of hepatic reserve, complementing MELD in prognosis and pre-operative assessment.
Frequently asked questions
What do Child-Pugh classes A, B and C mean?
Class A (5–6) is well-compensated cirrhosis with a good prognosis, Class B (7–9) reflects significant compromise, and Class C (10–15) is decompensated disease with the poorest survival and highest procedural risk.
What variables make up the score?
It combines serum bilirubin, serum albumin and prothrombin time or INR with two clinical features — ascites and hepatic encephalopathy. Each is scored 1 to 3 by severity, giving a total from 5 to 15.
How does it differ from MELD?
Child-Pugh includes clinical features (ascites and encephalopathy) and groups patients into classes, while MELD is a purely laboratory-based continuous score. MELD is generally used for transplant prioritisation and Child-Pugh for prognosis and surgical risk.
Is it used to assess surgical risk?
Yes. The class helps predict how well a patient with cirrhosis will tolerate surgery or invasive procedures, with Class C patients at substantially higher risk. It is one part of a fuller pre-operative assessment.
Can it be used in acute liver failure?
No. Child-Pugh was developed for chronic liver disease and cirrhosis. Acute liver failure is assessed with different criteria and requires urgent specialist input.
References
- Pugh RNH, Murray-Lyon IM, Dawson JL, et al. 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.
Related calculators
Need a calculator we don't have — or a custom tool?
We build evidence-led clinical calculators, dashboards and reference tools for teams.