Calculate Child-Pugh score and class for liver cirrhosis severity. Predicts survival, perioperative mortality, and guides transplant evaluation.
The Child-Pugh Score Calculator evaluates the severity of chronic liver disease and cirrhosis using five clinical and laboratory parameters: total bilirubin, serum albumin, INR (or prothrombin time), ascites, and hepatic encephalopathy. Originally developed by Child and Turcotte in 1964 and modified by Pugh in 1973, this classification system remains fundamental to hepatology practice.
Patients are classified into three classes: Class A (5-6 points, well-compensated), Class B (7-9 points, significant functional compromise), and Class C (10-15 points, decompensated cirrhosis). These classes correlate with 1-year survival rates of approximately 100%, 80%, and 45% respectively.
The Child-Pugh score guides clinical decisions about surgical risk, medication dosing in liver disease, portal hypertension management, and candidacy for liver transplantation evaluation. It is used alongside the MELD score, which provides continuous scoring for transplant prioritization. Check the example with realistic values before reporting. Use the steps shown to verify rounding and units. Cross-check this output using a known reference case.
Chronic liver disease severity varies enormously, from completely compensated to immediately life-threatening. The Child-Pugh classification stratifies patients into clinically meaningful categories that predict survival, guide surgery decisions, and inform treatment strategies.
For surgical planning, the Child-Pugh class directly impacts risk assessment — Class C patients face 80% perioperative mortality for abdominal surgery, often making conservative management preferable.
Child-Pugh Score = Bilirubin (1-3) + Albumin (1-3) + INR (1-3) + Ascites (1-3) + Encephalopathy (1-3) Total Range: 5-15 Class A: 5-6 (well-compensated) Class B: 7-9 (significant compromise) Class C: 10-15 (decompensated)
Result: Score 5 — Class A (Well-Compensated)
Bilirubin <2 (1) + albumin ≥3.5 (1) + INR <1.7 (1) + no ascites (1) + no encephalopathy (1) = 5 points. Class A indicates well-compensated liver disease with >85% 2-year survival.
Abdominal surgery in cirrhosis carries significantly elevated risk. Child-Pugh A patients have perioperative mortality of approximately 10%, comparable to non-cirrhotic patients for many procedures. Class B patients have 30% mortality, warranting careful risk-benefit analysis. Class C patients face 80% mortality, making elective surgery generally contraindicated.
Child-Pugh class guides portal hypertension management: beta-blocker prophylaxis for varices, TIPS candidacy (generally contraindicated in Class C with MELD >18), and timing of endoscopic surveillance. Variceal bleeding in Class C patients carries >50% 6-week mortality.
Many medications require dose reduction or avoidance in Child-Pugh B and C. Hepatically metabolized drugs (benzodiazepines, opioids, statins, some antibiotics) may have prolonged half-lives. The Child-Pugh class is specifically referenced in FDA labeling for dose adjustment recommendations.
Child-Pugh classifies into 3 broad categories while MELD provides a continuous score (6-40). MELD uses only objective lab values (bilirubin, INR, creatinine) without subjective components like ascites grading. MELD is preferred for transplant organ allocation; Child-Pugh is better for general clinical assessment and surgical risk.
Both are useful. Child-Pugh classes (A, B, C) have well-established perioperative mortality correlations. MELD scores >15 correlate with significant surgical risk. The Mayo Postoperative Mortality Model incorporates MELD with other variables for specific surgical risk estimation.
Yes. Ascites and encephalopathy grading are subjective and may vary between assessors. The score does not account for renal function (an important prognostic factor). The ceiling effect at 15 points limits discrimination among the sickest patients.
The score was primarily validated in alcoholic and hepatitis B cirrhosis. It applies broadly but may be less accurate for specific etiologies. For PBC, modified scoring uses bilirubin cutoffs of 1-4 and 4-10 instead of the standard 2 and 3.
Yes, particularly with abstinence from alcohol, successful treatment of hepatitis B/C, TIPS placement for refractory ascites, or management of precipitating factors for encephalopathy. Improvement from Class C to B carries significant prognostic benefit.
Transplant evaluation should begin for Class C patients, Class B patients with complications (variceal bleeding, HCC, recurrent encephalopathy), and when MELD exceeds 15. Listing is typically at MELD ≥15 with regional variation.