Medical AIChild-Pugh cirrhosis severity calculator
The Child-Pugh score grades cirrhosis severity from five variables (bilirubin, albumin, INR, ascites, and encephalopathy), each scored 1 to 3. The total of 5 to 15 maps to Class A, B, or C, which correlates with survival and surgical risk and is still widely used in hepatology.
How to measure each input
- Total bilirubin
- Use total serum bilirubin. In cholestatic disease (primary biliary cholangitis, primary sclerosing cholangitis) some modifications shift the thresholds upward, since bilirubin is chronically high.
- Serum albumin
- Measured serum albumin in g/dL (or g/L). Recent albumin infusions, sepsis, and nephrotic-range protein loss can lower albumin independently of liver synthetic function.
- INR / prothrombin time
- The original score used prothrombin time prolongation in seconds; INR thresholds are the common contemporary equivalent. Anticoagulants invalidate this variable.
- Ascites
- Grade clinically and on imaging: none, mild (diuretic-responsive), or moderate to severe (tense or refractory). This is a subjective component.
- Encephalopathy
- Grade by the West Haven criteria: none, grade 1 to 2 (mild confusion to lethargy), or grade 3 to 4 (stupor to coma). Also subjective and examiner-dependent.
Interpretation
| Band | Meaning |
|---|---|
| 5 to 6, Class A (well compensated) | Well-compensated disease. Approximately 100 percent 1-year and 85 percent 2-year survival in the original cohorts. Lowest perioperative risk among the classes. |
| 7 to 9, Class B (significant compromise) | Significant functional compromise. Approximately 80 percent 1-year and 60 percent 2-year survival. Elevated surgical risk; many elective procedures need careful risk-benefit review. |
| 10 to 15, Class C (decompensated) | Decompensated disease. Approximately 45 percent 1-year and 35 percent 2-year survival. High surgical mortality; prioritise transplant evaluation and complication management. |
Pitfalls, exclusions and caveats
- Two of the five variables, ascites and encephalopathy, are subjective and examiner-dependent, which limits reproducibility between assessors.
- The score uses fixed thresholds with no weighting for how far a value exceeds a cut-off, so it is less granular than the continuous MELD-Na.
- Anticoagulation invalidates the INR component, and albumin infusions or sepsis distort the albumin component.
- Cholestatic diseases (PBC, PSC) run chronically high bilirubin, and some versions raise the bilirubin thresholds to avoid over-scoring these patients.
- Child-Pugh predicts general prognosis and surgical risk but is not the basis for current transplant allocation, where MELD-based scores are used.
Sum five variables, each 1 to 3 points: total bilirubin (< 2 / 2 to 3 / > 3 mg/dL), albumin (> 3.5 / 2.8 to 3.5 / < 2.8 g/dL), INR (< 1.7 / 1.7 to 2.3 / > 2.3), ascites (none / mild / moderate to severe), encephalopathy (none / grade 1 to 2 / grade 3 to 4). Total 5 to 15: Class A 5 to 6, Class B 7 to 9, Class C 10 to 15.The score derives from Child and Turcotte (1964) as modified by Pugh et al. (1973). This implementation is an educational tool and is not affiliated with the original authors or any guideline body.
Frequently asked
What is the difference between Child-Pugh Class A, B, and C?
Class A (5 to 6 points) is well-compensated cirrhosis with the best survival. Class B (7 to 9) reflects significant compromise. Class C (10 to 15) is decompensated disease with the poorest survival and highest surgical risk.
Is Child-Pugh or MELD better?
They serve different purposes. MELD-based scores are objective, continuous, and used for transplant allocation. Child-Pugh remains popular for bedside grading and surgical risk, but two of its variables are subjective, which reduces reproducibility.
What albumin and bilirubin values change the points?
Albumin scores 1 point above 3.5 g/dL, 2 points from 2.8 to 3.5, and 3 points below 2.8. Bilirubin scores 1 point below 2 mg/dL, 2 points from 2 to 3, and 3 points above 3 (with higher thresholds in cholestatic disease).
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