Child-Pugh score calculator
Grade the severity of cirrhosis from five items: encephalopathy, ascites, bilirubin, albumin and INR. This calculator adds the points from the Pugh 1973 table and shows the Child-Pugh class A, B or C.
How this Child-Pugh calculator works
This Child-Pugh calculator uses the table published by Pugh and colleagues in the British Journal of Surgery in 1973, who modified the earlier Child and Turcotte grading for patients having oesophageal transection for bleeding varices. Pugh dropped nutritional status and added prothrombin time. Each of five items scores 1, 2 or 3 points, and the total runs from 5 to 15. The original paper scored clotting as seconds of prothrombin time prolongation (1–4, 4–6, over 6 seconds); most current use, and this calculator, scores the INR instead. Bilirubin of 2 and 3 mg/dL is about 34 and 51 µmol/L, usually rounded to 34 and 50, and albumin in g/L is g/dL times 10.
| Item | 1 point | 2 points | 3 points |
|---|---|---|---|
| Hepatic encephalopathy | None | Grade 1–2 | Grade 3–4 |
| Ascites | None | Slight | Moderate to severe |
| Bilirubin | Under 2 mg/dL (under 34 µmol/L) | 2–3 mg/dL (34–50 µmol/L) | Over 3 mg/dL (over 50 µmol/L) |
| Albumin | Over 3.5 g/dL (over 35 g/L) | 2.8–3.5 g/dL (28–35 g/L) | Under 2.8 g/dL (under 28 g/L) |
| INR | Under 1.7 | 1.7–2.3 | Over 2.3 |
| Prothrombin time (original) | 1–4 s prolonged | 4–6 s prolonged | Over 6 s prolonged |
Child-Pugh score = encephalopathy + ascites + bilirubin + albumin + INR points (5 to 15)
Child-Pugh classes A, B and C
The Child-Pugh score sorts the total into three classes, which Pugh called grades. Class A, 5 or 6 points, is well-compensated cirrhosis; class B, 7 to 9 points, is moderate dysfunction; and class C, 10 to 15 points, is severe dysfunction. Child and Turcotte first used the grades to estimate operative risk, and the classes are now used more widely to describe how well the liver is working. Class B is sometimes reported by its exact score, as B7, B8 or B9.
| Class | Points | Description |
|---|---|---|
| A | 5–6 | Well-compensated |
| B | 7–9 | Moderate dysfunction |
| C | 10–15 | Severe dysfunction |
When the Child-Pugh score is less accurate
Two of the five Child-Pugh items, ascites and encephalopathy, are graded by clinical judgment, so two clinicians can score the same patient differently, and treatment can lower both grades. INR varies between laboratories and does not fully reflect clotting in cirrhosis. Albumin falls with poor nutrition and rises with infused albumin. Each item tops out at 3 points, so very high bilirubin or INR adds no more to the score. Kidney function, which the MELD score includes, is not part of Child-Pugh.
Questions
What is the difference between Child-Pugh and MELD?
Child-Pugh adds points for five items, two of them clinical grades, and gives a class from A to C. MELD is calculated from three lab values, bilirubin, creatinine and INR, and is used to rank candidates for liver transplant. A 2016 meta-analysis of 119 studies found the two scores had similar prognostic value in most settings, with differences in some groups, such as patients in intensive care or having surgery.
Why does the calculator use INR instead of prothrombin time?
Pugh's 1973 table scored the seconds of prothrombin time prolongation over control. Prothrombin time in seconds differs between laboratories, so most current versions use INR, with under 1.7, 1.7–2.3 and over 2.3 as the cut-offs for 1, 2 and 3 points.
Can I use bilirubin in µmol/L or albumin in g/L?
Yes. Pick µmol/L under bilirubin or g/L under albumin and the options switch to those units. Bilirubin in mg/dL times 17.1 gives µmol/L, and albumin in g/dL times 10 gives g/L.
Is my data sent anywhere?
No. The calculation runs in your browser, and the options you pick are not sent or stored.
Sources
- Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. doi:10.1002/bjs.1800600817
- Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95(8):e2877. doi:10.1097/MD.0000000000002877
- Decraecker M, Bourien H, Blanc JF, Edeline J. Impact of Child Pugh B stage for the treatment of advanced HCC. J Hepatocell Carcinoma. 2026;13:579537. doi:10.2147/JHC.S579537