How is the Child-Pugh score calculated?

Five parameters are each scored 1, 2, or 3: total bilirubin, albumin, INR, ascites, and encephalopathy. The points are added to give a total of 5 to 15. Five to 6 is class A, 7 to 9 is class B, and 10 to 15 is class C.

What do classes A, B, and C mean?

Class A is well-compensated cirrhosis with near-normal function and good survival. Class B shows significant functional compromise. Class C is decompensated disease with the poorest prognosis and the highest surgical risk.

What survival does each class predict?

Class A carries roughly 95 to 100 percent one-year survival, class B about 80 percent, and class C about 45 percent. Two-year figures are lower across the board. These are population estimates and depend on the cause of liver disease.

How does Child-Pugh differ from MELD?

Child-Pugh uses two subjective clinical findings, ascites and encephalopathy, alongside three labs, and gives a category. MELD uses only objective labs and gives a continuous score. MELD is preferred for transplant allocation, while Child-Pugh is common for surgical risk and bedside staging.

What are the bilirubin and albumin cutoffs?

Bilirubin scores 1 below 2 mg/dL, 2 from 2 to 3, and 3 above 3. Albumin scores 1 above 3.5 g/dL, 2 from 2.8 to 3.5, and 3 below 2.8. INR scores 1 below 1.7, 2 from 1.7 to 2.3, and 3 above 2.3.

Child-Pugh Score Calculator

The Child-Pugh score, originally the Child-Turcotte-Pugh classification, grades the severity of chronic liver disease. It combines two laboratory measures of synthetic function, one of cholestasis, and two clinical signs of decompensation into a simple A, B, or C category that has guided prognosis and surgical decisions for decades.

How it works

Each of five parameters is scored 1, 2, or 3:

Bilirubin (mg/dL):  <2 = 1 | 2-3 = 2 | >3 = 3
Albumin (g/dL):     >3.5 = 1 | 2.8-3.5 = 2 | <2.8 = 3
INR:                <1.7 = 1 | 1.7-2.3 = 2 | >2.3 = 3
Ascites:            none = 1 | mild = 2 | moderate-severe = 3
Encephalopathy:     none = 1 | grade 1-2 = 2 | grade 3-4 = 3

The five points are summed:

5-6   = Class A
7-9   = Class B
10-15 = Class C

Example and notes

A patient with bilirubin 1.5 (1 point), albumin 3.0 (2), INR 1.5 (1), mild ascites (2), and no encephalopathy (1) scores 7, which is class B. The two clinical inputs introduce some observer variability, so document the basis for the ascites and encephalopathy grades. Child-Pugh remains widely used for surgical risk stratification, while MELD is generally preferred for transplant prioritisation.