Child-Pugh Score Calculator

Calculate Your Child-Pugh Score

Enter bilirubin, albumin, INR, and select ascites/encephalopathy severity. The score and cirrhosis class update automatically as you type.

How to Use Child-Pugh Score Calculator

1. Step 1: Choose Units

   Select units for bilirubin (mg/dL or µmol/L) and albumin (g/dL or g/L) to match your lab report.

2. Step 2: Enter Lab Values

   Type total bilirubin, serum albumin, and INR into the inputs. The score updates automatically as you type.

3. Step 3: Select Clinical Findings

   Choose ascites severity (none, mild/moderate, severe) and hepatic encephalopathy grade (none, Grade I–II, Grade III–IV).

4. Step 4: Read Your Score

   View the total Child-Pugh score (5–15), Class A/B/C badge, visual score bar, and per-criterion points breakdown.

5. Step 5: Review Survival & Risk

   Check the 1-year and 2-year survival estimates, operative mortality risk, and the classification reference table.

6. Step 6: Copy or Compare

   Use the Copy Summary button for documentation, or compare with our MELD score calculator for transplant prioritization.

Key Features

• Auto-calculates Child‑Pugh class (A/B/C) as you type
• Per-criterion points breakdown with visual score bar
• 1-year and 2-year survival estimates per class
• Unit toggles for bilirubin (mg/dL/µmol/L) and albumin (g/dL/g/L)
• Copy summary button for clinical documentation
• Mobile sticky result bar for quick reference

Understanding Your Child-Pugh Score Results

Child-Pugh Score Formula

The Child-Pugh score assigns 1–3 points to five criteria: total bilirubin (<2, 2–3, >3 mg/dL), serum albumin (>3.5, 2.8–3.5, <2.8 g/dL), INR (<1.7, 1.7–2.3, >2.3), ascites (none, mild/moderate, severe), and hepatic encephalopathy (none, Grade I–II, Grade III–IV). The sum (5–15) maps to Class A (5–6), Class B (7–9), or Class C (10–15).

Child-Pugh Classification Chart

Class A (5–6 points) reflects well-compensated cirrhosis with approximately 100% one-year survival. Class B (7–9 points) indicates significant functional compromise with ~80% one-year survival. Class C (10–15 points) signals decompensated disease with ~45% one-year survival and ~80% perioperative mortality. For transplant allocation and short-term mortality prediction, also calculate the MELD/MELD-Na score.

Assumptions & Limitations

Albumin can be low for non-hepatic reasons (malnutrition, nephrotic syndrome). INR may be elevated by warfarin or antibiotics. Ascites and encephalopathy grading is semi-subjective. Cholestatic diseases like PBC may inflate the bilirubin score. Always interpret the Child-Pugh score in clinical context. For detailed background, see NCBI StatPearls: Child-Turcotte-Pugh Classification.

Complete Guide: Child-Pugh Score Calculator

A child pugh score calculator converts five bedside measurements into a single cirrhosis severity grade—Class A, B, or C—in seconds. Hepatologists, surgeons, and primary-care providers rely on this score daily because it condenses albumin, bilirubin, INR, ascites status, and encephalopathy into one number that drives decisions about surgery, transplant referral, and follow-up intensity.

The scoring system was introduced by Child and Turcotte in 1964 and later modified by Pugh in 1973 to replace the original prothrombin time criterion with INR. Over half a century later it remains one of the most-cited tools in hepatology—simple enough to use at the bedside, yet informative enough to shape major clinical decisions.

What the Child-Pugh score measures

The Child-Turcotte-Pugh (CTP) score quantifies chronic liver disease severity, particularly cirrhosis. It blends three lab markers of synthetic and excretory function—albumin, total bilirubin, and INR—with two clinical observations: ascites and hepatic encephalopathy. The total ranges from 5 to 15 points.

Why these five? Bilirubin tracks the liver’s ability to process and excrete waste. Albumin and INR reflect synthetic capacity (protein and clotting factors). Ascites signals portal hypertension and sodium handling. Encephalopathy captures the brain’s exposure to toxins the liver can no longer clear. Together they paint a fuller picture than any single lab value could.

Because the score is simple and universally taught, teams across hepatology, surgery, anesthesia, and critical care communicate quickly using the same Class A/B/C shorthand. Surgeons, for example, commonly defer elective abdominal operations in Class C patients; many Class A patients can proceed after standard risk assessment.

The scoring formula step by step

Each criterion earns 1, 2, or 3 points based on fixed thresholds. Here are the exact cutoffs our calculator uses:

Sum all five to get the total (minimum 5, maximum 15). Labs may be reported in different units—our calculator supports bilirubin in mg/dL or µmol/L and albumin in g/dL or g/L, converting automatically. A quick note: the Child-Pugh score uses total bilirubin, not direct (conjugated) bilirubin.

Child-Pugh score chart: classification at a glance

Below is the classification table with historical survival data and perioperative risk estimates. These numbers come from aggregated cohort studies and vary by etiology, comorbidities, and era of care—treat them as benchmarks, not predictions for individual patients.

The jump between classes isn’t gradual—moving from Class A to B often reflects a real shift in clinical trajectory. A patient at score 6 (Class A) and one at 7 (Class B) are separated by just one point, but that boundary can change surgical eligibility, insurance documentation, and transplant discussion timelines.

The five criteria explained

Total bilirubin reflects excretory function. When hepatocytes or bile ducts are damaged, bilirubin accumulates and jaundice may develop. The Child-Pugh thresholds (<2, 2–3, >3 mg/dL) are intentionally broad—they flag meaningful shifts in clearance, not minor lab fluctuations. If your lab uses µmol/L, divide by 17.1 (or let our calculator convert automatically).

Serum albumin tracks synthetic capacity. Lower values point to reduced protein production and contribute to edema and ascites through decreased oncotic pressure. But hypoalbuminemia is multifactorial: malnutrition, renal losses, and systemic inflammation can all suppress it. In clinical practice, most hepatologists consider albumin trends over weeks rather than single-day readings.

INR captures clotting factor synthesis. As cirrhosis advances, the balance between pro- and anticoagulant factors shifts and INR tends to rise. Be aware that warfarin, certain antibiotics, and vitamin K deficiency can elevate INR independently of liver disease—that’s one reason the Child-Pugh score should never be interpreted in isolation.

Ascites indicates portal hypertension and sodium/water dysregulation. “Mild/moderate” generally means controlled with diuretics and outpatient monitoring; “severe” or refractory ascites implies frequent paracentesis or hospitalization. Ultrasound is helpful when physical exam findings are equivocal.

Hepatic encephalopathy ranges from subtle concentration lapses and sleep-wake reversal (Grade I–II) to somnolence, confusion, and coma (Grade III–IV). Precipitating factors include constipation, GI bleeding, infection, and sedatives. The West Haven criteria provide a standardized framework—ask caregivers about baseline versus current cognition to reduce inter-observer variability.

Child-Pugh Class C: what decompensation really means

Class C (score 10–15) carries clinical weight that the number alone doesn’t convey. Patients in this category face overlapping complications: refractory ascites requiring frequent large-volume paracentesis, spontaneous bacterial peritonitis (SBP) risk of 10–30% per year, recurrent hepatic encephalopathy limiting independence, and variceal bleeding from portal hypertension.

Perioperative mortality in Class C historically runs around 80% for abdominal surgery. That figure alone explains why most surgeons avoid elective procedures in decompensated cirrhosis without prior optimization. From a transplant perspective, Class C patients should be evaluated early—waiting for further decline narrows the window for successful outcomes.

Class C doesn’t always mean end-stage. Acute precipitants like infection, dehydration, or medication effects can push a Class B patient temporarily into C territory. If the Child-Pugh score worsens suddenly, look for reversible triggers before assuming irreversible progression.

Child-Pugh vs. MELD: which score should you use?

MELD (Model for End-Stage Liver Disease) uses only lab values—bilirubin, creatinine, INR, and sodium in MELD-Na—to produce a continuous 6–40 score. It was designed for transplant allocation because it predicts 90-day mortality more precisely than a three-category system. Child-Pugh, by contrast, blends objective labs with two bedside clinical findings, giving a holistic severity snapshot.

Neither replaces clinical judgment. If you’re evaluating complications or considering escalation of care, calculate both: try the MELD score calculator alongside this page. Child-Pugh is better for describing overall condition to colleagues and patients; MELD is better for transplant listing and short-term risk stratification.

For broader liver assessment, you may also find these useful: liver function calculator for a general panel, AST/ALT ratio calculator for distinguishing alcoholic from non-alcoholic liver injury, and creatinine clearance calculator for renal function (a key MELD component).

Child Pugh score calculator: worked examples with real numbers

Example 1 — compensated cirrhosis (Class A). A 52-year-old with hepatitis C cirrhosis presents with albumin 3.7 g/dL (1 pt), bilirubin 1.5 mg/dL (1 pt), INR 1.3 (1 pt), no ascites (1 pt), no encephalopathy (1 pt). Total = 5 → Class A. Management: surveillance for varices and hepatocellular carcinoma, vaccination, nutrition counseling, and ongoing antiviral therapy if not yet achieved SVR.

Example 2 — moderate compromise (Class B). A 64-year-old with alcoholic cirrhosis: albumin 3.1 g/dL (2 pts), bilirubin 2.6 mg/dL (2 pts), INR 1.9 (2 pts), mild ascites on diuretics (2 pts), no encephalopathy (1 pt). Total = 9 → Class B. Action items: sodium restriction, diuretic titration, alcohol cessation support, and transplant referral discussion depending on MELD trajectory.

Example 3 — decompensated disease (Class C). A 70-year-old with NASH cirrhosis: albumin 2.5 g/dL (3 pts), bilirubin 3.4 mg/dL (3 pts), INR 2.5 (3 pts), severe ascites (3 pts), Grade II encephalopathy (2 pts). Total = 14 → Class C. Focus shifts to complication management, safety at home, caregiver support, and honest goals-of-care discussion including transplant eligibility versus palliative measures.

Borderline case — A/B transition. A patient fluctuates between albumin 3.4 and 3.6 g/dL and between mild ascites and none. On one visit the total is 6 (Class A), on the next 7 (Class B). Rather than fixating on the letter, document the drivers of change and whether they are reversible—sodium intake, diuretic compliance, infection, or GI bleeding. Sustained improvement matters more than a single threshold crossing.

Common mistakes and pitfalls

Using direct instead of total bilirubin. The Child-Pugh score requires total bilirubin. Direct (conjugated) bilirubin alone will underestimate the true value and can shift the score by 1–2 points. Always confirm which bilirubin your lab reported.

Ignoring medication effects on INR. A patient on warfarin with an INR of 2.8 will score 3 points for INR—but that elevation may have nothing to do with liver function. Where possible, use the pre-warfarin INR or note the confound when documenting the score.

Inconsistent encephalopathy grading. Grade I-II can be subtle—mild asterixis, reversed sleep pattern, or impaired concentration that the patient themselves may not report. Use the West Haven descriptors consistently, and ask a family member or caregiver about cognitive baseline. A missed Grade I-II doesn’t just undercount the score; it delays lactulose or rifaximin initiation.

Treating the score as static. A single snapshot is informative, but the trajectory matters more. Acute events—infection, GI bleed, dehydration—can transiently worsen all five criteria. If the score jumps by 2+ points over days, investigate and treat the precipitant before concluding the disease has progressed irreversibly.

References and sources

• Child-Turcotte-Pugh Classification — StatPearls, NCBI Bookshelf (NIH)
• American Association for the Study of Liver Diseases (AASLD) practice resources
• 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.

This content is informational and does not constitute a medical diagnosis or treatment plan. Always discuss your Child-Pugh score results with a qualified healthcare provider.

Frequently Asked Questions