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Child–Pugh Score

Severity of cirrhosis from bilirubin, albumin, INR, ascites and encephalopathy.

For healthcare professionalsLiverv1.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

Ascites
Hepatic encephalopathy

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

Child–Turcotte–Pugh (Pugh 1973)

Bilirubin <2 / 2–3 / >3 mg/dL; albumin >3.5 / 2.8–3.5 / <2.8 g/dL; INR <1.7 / 1.7–2.3 / >2.3; ascites; encephalopathy — each 1–3 points

Classes A (5–6), B (7–9) and C (10–15) are widely used for prognosis and drug dosing in cirrhosis. The 1973 paper used prothrombin time in seconds; this calculator uses the common INR substitute.

Who it is for
Adults with cirrhosis.
Version
1.0.1

How this calculator works

Where the formula comes from

  • Pugh and colleagues (1973) modified the Child–Turcotte classification, replacing nutritional status with prothrombin time and scoring each of five variables 1–3 points, in patients undergoing oesophageal transection for bleeding varices.[1]

The inputs

  • The five variables are bilirubin, albumin, prothrombin time (now often INR), ascites and hepatic encephalopathy, giving a total of 5–15 (class A 5–6, B 7–9, C 10–15).[1]
  • The 1973 paper used prothrombin time prolongation in seconds; INR thresholds of under 1.7, 1.7–2.3 and over 2.3 are a later substitute.[1]

Versions and alternatives

  • MELD is an alternative laboratory-based prognostic score; studies, including a 2016 meta-analysis, have compared its prognostic performance with Child–Pugh.[2][3]

Where accuracy falls (published evidence)

  • Grading of ascites and encephalopathy is subjective, and the score does not include kidney function.[3]

What guidelines say

  • The 2018 EASL guideline on decompensated cirrhosis uses Child–Pugh, together with MELD, to describe the severity of liver disease.[4]

Sources

  1. 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
  2. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172
  3. 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
  4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460. doi:10.1016/j.jhep.2018.03.024

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate child–Pugh

Inputs

Total bilirubin
2.5 mg/dL
Serum albumin
3 g/dL
INR
1.5
Ascites
Slight, or controlled with diuretics
Hepatic encephalopathy
None

Result

Child–Pugh points
8 of 15

Class B (7–9): significant functional compromise

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Ascites and encephalopathy grading is subjective.

References

  1. 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

Continue with your measurements

Shared measurements carry over automatically, in this tab only.

For healthcare professionals

MELD, MELD-Na and MELD 3.0

Model for End-Stage Liver Disease: original, sodium (2016 UNOS) and MELD 3.0 (2023 OPTN) versions.

Professional~3 min

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