Child-Pugh Score Calculator
Enter bilirubin, albumin, INR or PT prolongation, and the severity of ascites and encephalopathy to get the Child-Pugh score (5–15 points) and class A, B or C for cirrhosis severity.
Classify Cirrhosis Severity with the Child-Pugh Score
Child-Pugh Score Formula
Where:
- \(P_{\text{bilirubin}}\) — points for total bilirubin (mg/dL): 1 if <2, 2 if 2–3, 3 if >3
- \(P_{\text{albumin}}\) — points for serum albumin (g/dL): 1 if >3.5, 2 if 2.8–3.5, 3 if <2.8
- \(P_{\text{clotting}}\) — points for INR: 1 if <1.7, 2 if 1.7–2.3, 3 if >2.3 (or PT prolongation: <4 s, 4–6 s, >6 s)
- \(P_{\text{ascites}}\) — 1 for none, 2 for slight (medically controlled), 3 for moderate to severe (poorly controlled)
- \(P_{\text{encephalopathy}}\) — 1 for none, 2 for grade I–II, 3 for grade III–IV
Each of the five parameters earns 1, 2 or 3 points, so the total score ranges from 5 to 15. The total is then mapped to a class: A (5–6 points), B (7–9) or C (10–15).
Child-Pugh Score – Calculation Example
Example: a patient with cirrhosis has a total bilirubin of 2.5 mg/dL, serum albumin of 3.0 g/dL, INR of 1.8, slight ascites controlled with medication, and no hepatic encephalopathy.
\[ P_{\text{bili}} = 2 \;(2.5 \text{ mg/dL is in the 2–3 range}), \quad P_{\text{alb}} = 2 \;(3.0 \text{ g/dL is in the 2.8–3.5 range}) \]
\[ P_{\text{INR}} = 2 \;(1.8 \text{ is in the 1.7–2.3 range}), \quad P_{\text{asc}} = 2, \quad P_{\text{enc}} = 1 \]
\[ \text{Score} = 2 + 2 + 2 + 2 + 1 = 9 \text{ points} \]
Result: 9 points — Child-Pugh Class B, indicating significant functional compromise of the liver.
How to Use the Child-Pugh Score Calculator
- Enter your Total bilirubin from your blood test and select the unit (mg/dL or µmol/L).
- Enter your Serum albumin and select the unit (g/dL or g/L).
- Choose the Clotting measure you have — INR or PT prolongation — and enter the value in the INR / PT prolongation field. If you choose PT prolongation, enter the number of seconds above the control value (e.g. 4.5), not the total prothrombin time.
- Select the severity of Ascites: none, slight (controlled medically), or moderate to severe (poorly controlled).
- Select the degree of Hepatic encephalopathy: none, grade I–II (mild), or grade III–IV (severe).
- Read your total score (5–15 points), your Child-Pugh class (A, B or C), and the interpretation of the result.
What Is the Child-Pugh Score?
The Child-Pugh score (also called the Child-Turcotte-Pugh score) is one of the oldest and most widely used tools for grading the severity of chronic liver disease and cirrhosis. It combines two laboratory values (bilirubin and albumin), one measure of blood clotting (INR or prothrombin time), and two clinical features (ascites and hepatic encephalopathy) into a single number from 5 to 15.
The score divides patients into three classes. Class A (5–6 points) represents well-compensated cirrhosis — the liver still performs most of its functions despite the scarring. Class B (7–9 points) indicates significant functional compromise, and Class C (10–15 points) represents decompensated cirrhosis, where complications such as fluid retention, bleeding risk and confusion have become prominent.
The classification matters because it correlates with survival and surgical risk. In the classic 1973 dataset from Pugh and colleagues, one-year survival was roughly 100% for Class A, 80% for Class B and 45% for Class C, and perioperative mortality rose from about 10% in Class A to over 80% in Class C. Clinicians still use the score to help decide whether elective surgery is reasonably safe, to assess prognosis, and to communicate disease severity in a standardized way. For prioritizing patients for liver transplantation, however, the MELD-Na score has largely replaced Child-Pugh.
Reference Table
| Parameter | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin (mg/dL) | < 2 | 2–3 | > 3 |
| Serum albumin (g/dL) | > 3.5 | 2.8–3.5 | < 2.8 |
| INR | < 1.7 | 1.7–2.3 | > 2.3 |
| PT prolongation (s) | < 4 | 4–6 | > 6 |
| Ascites | None | Slight | Moderate to severe |
| Hepatic encephalopathy | None | Grade I–II | Grade III–IV |
Class A = 5–6 points, Class B = 7–9 points, Class C = 10–15 points.
Assumptions, Limitations and Practical Tips
- It applies to cirrhosis, not acute liver failure. The Child-Pugh score was validated in patients with chronic liver disease and portal hypertension; it is not designed for acute conditions.
- Two of the five parameters are clinical judgments. The grading of ascites and encephalopathy depends on how well symptoms are controlled with treatment, so the same patient can score differently over time. An ultrasound-free bedside assessment of ascites and a careful history for encephalopathy are needed.
- Interpret borderline values carefully. The score uses fixed cut-offs, so a bilirubin of 1.9 versus 2.1 mg/dL changes the points even though the clinical difference is tiny. The original Pugh paper also noted that bilirubin thresholds differ in cholestatic diseases such as primary biliary cholangitis.
- Unit conversions matter. Bilirubin in µmol/L is converted using \(1 \text{ mg/dL} = 17.1\ \mu\text{mol/L}\), and albumin in g/L is divided by 10. Double-check the units on your lab report before entering values.
- Anticoagulants affect the INR. If the patient takes warfarin, the INR reflects the medication rather than liver synthetic function, which can inflate the score.
- This is an informational tool, not a diagnosis. Always discuss the result with a hepatologist or treating physician. For broader liver risk screening in suspected fibrosis, see the FIB-4 score calculator; if cirrhosis affects treatment decisions for atrial fibrillation, the HAS-BLED score calculator can help estimate bleeding risk.
Frequently Asked Questions
How do I calculate the Child-Pugh score by hand?
Assign 1, 2 or 3 points to each of five parameters: total bilirubin, serum albumin, INR (or PT prolongation), ascites, and hepatic encephalopathy. Then simply add them up — the total always falls between 5 and 15. For example, bilirubin 3.2 mg/dL (3 pts), albumin 3.9 g/dL (1 pt), INR 1.4 (1 pt), no ascites (1 pt), grade I encephalopathy (2 pts) gives 8 points, which is Class B.
What is a good or normal Child-Pugh score?
A score of 5 is the best possible result and 15 is the worst. Class A (5–6 points) is considered well-compensated cirrhosis with the best prognosis — roughly 100% one-year survival in the classic data. Class B (7–9) indicates significant liver compromise, while Class C (10–15) means decompensated disease with the highest surgical and mortality risk. There is no truly "normal" score; any diagnosis of cirrhosis is serious.
Can I use bilirubin in µmol/L or albumin in g/L?
Yes. The calculator accepts both units and converts them internally. To do it yourself: divide bilirubin in µmol/L by 17.1 to get mg/dL, and divide albumin in g/L by 10 to get g/dL. For example, 34 µmol/L ≈ 2 mg/dL, and 30 g/L = 3.0 g/dL. Always check the unit printed on your lab report before entering a value — mixing them up is one of the most common mistakes.
Why does the score use INR or PT prolongation — which should I enter?
The original 1973 scoring used prothrombin time prolongation (seconds above the control value), while INR is the modern standardized equivalent. Use whichever value your lab report provides. If you enter PT prolongation, enter only the seconds above the control — for example, if the control is 12 s and the patient's PT is 16.5 s, enter 4.5, not 16.5. INR and PT prolongation are not interchangeable numbers but map to the same 1–3 point scale.
Does taking warfarin or blood thinners affect the score?
Yes, significantly. INR measures how fast blood clots, but warfarin deliberately raises INR regardless of liver function. In a patient on warfarin, the INR reflects the medication rather than the liver's ability to produce clotting factors, which can inflate the Child-Pugh score. Mention anticoagulant use to the treating physician — they may interpret the clotting component differently or use PT values from before the drug was started.
Can the Child-Pugh score change over time?
Yes. Two of the five components — ascites and encephalopathy — are clinical assessments that depend on how well symptoms are controlled with treatment, and lab values also fluctuate. A patient whose ascites is well controlled by diuretics scores lower than the same patient with poorly controlled fluid buildup. This is why the score is typically recalculated at follow-up visits or before major treatment decisions.
What is the difference between Child-Pugh and MELD score?
Child-Pugh grades cirrhosis into classes A, B and C and is widely used for assessing surgical risk and overall prognosis. MELD (Model for End-Stage Liver Disease) uses bilirubin, INR, creatinine and sodium to predict short-term mortality and is the standard for liver transplant waiting-list prioritization. Child-Pugh is partly subjective (ascites and encephalopathy grading), while MELD relies only on objective lab values. Both are informational — discuss your results with a hepatologist.