Child-Pugh Calculator
The Child-Pugh score grades the severity of chronic liver disease (cirrhosis) using five parameters: total bilirubin, serum albumin, INR or prothrombin time, ascites and hepatic encephalopathy. Each scores 1 to 3 points, and the total of 5 to 15 places a patient in Class A, B or C. This calculator switches bilirubin and albumin between conventional and SI units, accepts INR or PT in seconds, and reports the points breakdown, estimated one and two year survival, and perioperative mortality. It is an educational estimate, not a substitute for a clinician.
Formula
Worked example
Bilirubin 1.5 mg/dL (1), albumin 3.8 g/dL (1), INR 1.2 (1), no ascites (1), no encephalopathy (1) sum to 5 points, which is Class A with roughly 100% one-year survival.
What the Child-Pugh score measures
The Child-Pugh score (originally Child-Turcotte, later modified by Pugh) estimates the prognosis of chronic liver disease, mainly cirrhosis. It combines two clinical findings, ascites and hepatic encephalopathy, with three laboratory values: total bilirubin, serum albumin and the clotting tendency measured by INR or prothrombin time. Each of the five parameters is scored 1, 2 or 3 points, so the total ranges from a best possible 5 to a worst possible 15. Clinicians use the score to gauge surgical risk, prioritise transplant evaluation, and adjust the dosing of drugs cleared by the liver.
How the classes are interpreted
A total of 5 to 6 points is Class A (well-compensated disease), 7 to 9 points is Class B (significant functional compromise), and 10 to 15 points is Class C (decompensated disease). Higher classes carry worse survival and higher operative mortality. Commonly cited figures put one-year survival around 100% for Class A, roughly 80% for Class B and about 45% for Class C, with two-year survival near 85%, 60% and 35% respectively. Perioperative mortality for major abdominal surgery rises steeply, from roughly 10% in Class A to about 30% in Class B and up to 70 to 80% in Class C. Published rates vary widely by cause of disease, era and cohort, so treat these as approximate.
Units, INR versus PT, and limitations
This tool lets you enter bilirubin in mg/dL or µmol/L and albumin in g/dL or g/L; it converts to the conventional units (dividing µmol/L by 17.1 and g/L by 10) before applying the standard cut-offs. For coagulation you can use INR (the modern standard) or the original prothrombin time prolongation in seconds over control, where under 4, 4 to 6 and over 6 seconds map to 1, 2 and 3 points. Two of the five inputs, ascites and encephalopathy, are graded by clinical judgement, which adds some subjectivity. The MELD score, which uses only objective lab values, is often used alongside Child-Pugh for transplant allocation.
Child-Pugh scoring chart
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin | < 2 mg/dL (< 34 µmol/L) | 2 - 3 mg/dL (34 - 51) | > 3 mg/dL (> 51 µmol/L) |
| Serum albumin | > 3.5 g/dL (> 35 g/L) | 2.8 - 3.5 g/dL (28 - 35) | < 2.8 g/dL (< 28 g/L) |
| INR | < 1.7 | 1.7 - 2.3 | > 2.3 |
| PT (seconds over control) | < 4 | 4 - 6 | > 6 |
| Ascites | Absent | Slight / responsive | Moderate / refractory |
| Encephalopathy | None | Grade 1-2 | Grade 3-4 |
Each of the five parameters scores 1, 2 or 3 points; the five are summed for a total of 5 to 15. SI equivalents are shown in brackets.
Frequently asked questions
What is a good Child-Pugh score?
The lowest possible score is 5, which corresponds to Class A and the best prognosis. Class A spans 5 to 6 points and reflects well-compensated cirrhosis with roughly 100% one-year survival. Higher totals indicate more advanced disease, with Class C (10 to 15 points) carrying the highest short-term mortality.
Can I use prothrombin time instead of INR?
Yes. The original Child-Pugh classification used prothrombin time prolongation in seconds over the control value: under 4 seconds scores 1 point, 4 to 6 seconds scores 2, and over 6 seconds scores 3. Switch the coagulation measure to PT and enter the seconds. The modern version uses INR, which most modern labs report, with cut-offs of 1.7 and 2.3.
My lab reports bilirubin in µmol/L and albumin in g/L. Can I still use this?
Yes. Choose µmol/L for bilirubin or g/L for albumin and enter the value directly; the calculator converts to mg/dL (divide µmol/L by 17.1) and g/dL (divide g/L by 10) before scoring, so you do not need to convert by hand.
How is Child-Pugh different from MELD?
Both grade liver disease severity, but Child-Pugh includes two subjective clinical findings (ascites and encephalopathy) alongside labs, while MELD uses only objective values (bilirubin, INR and creatinine). MELD is generally preferred for ranking transplant waiting lists because it avoids subjective grading.
Can I rely on this calculator for treatment decisions?
No. This tool provides an educational estimate of the Child-Pugh score and prognosis. Accurate scoring depends on correctly graded clinical findings and current lab values, and treatment decisions must be made by a qualified clinician who can interpret the score in the full clinical context.