How is the Child-Pugh score calculated?

Five parameters are each scored 1, 2, or 3: total bilirubin, albumin, INR, ascites, and encephalopathy. The points are added to give a total of 5 to 15. Five to 6 is class A, 7 to 9 is class B, and 10 to 15 is class C.

What do classes A, B, and C mean?

Class A is well-compensated cirrhosis with near-normal function and good survival. Class B shows significant functional compromise. Class C is decompensated disease with the poorest prognosis and the highest surgical risk.

What survival does each class predict?

Class A carries roughly 95 to 100 percent one-year survival, class B about 80 percent, and class C about 45 percent. Two-year figures are lower across the board. These are population estimates and depend on the cause of liver disease.

How does Child-Pugh differ from MELD?

Child-Pugh uses two subjective clinical findings, ascites and encephalopathy, alongside three labs, and gives a category. MELD uses only objective labs and gives a continuous score. MELD is preferred for transplant allocation, while Child-Pugh is common for surgical risk and bedside staging.

What are the bilirubin and albumin cutoffs?

Bilirubin scores 1 below 2 mg/dL, 2 from 2 to 3, and 3 above 3. Albumin scores 1 above 3.5 g/dL, 2 from 2.8 to 3.5, and 3 below 2.8. INR scores 1 below 1.7, 2 from 1.7 to 2.3, and 3 above 2.3.

What is the Child-Pugh Score Calculator?

Score bilirubin, albumin, INR, ascites, and encephalopathy to classify hepatic reserve as Child-Pugh class A, B, or C and estimate one- and two-year survival. A standard tool in hepatology and surgical risk assessment for cirrhosis. Runs in your browser. It runs free in your browser on Gera Tools, with nothing uploaded.

Child-Pugh Score Calculator

Name: Child-Pugh Score Calculator
Creator: Gera Tools
License: https://creativecommons.org/licenses/by/4.0/

Get one useful tool a week

Like this tool? Enter your email and we'll send you one genuinely useful Gera tool a week — plus a link to come back to this one. No spam, one-click unsubscribe any time.

The Child-Pugh score, originally the Child-Turcotte-Pugh classification, grades the severity of chronic liver disease. It combines two laboratory measures of synthetic function, one of cholestasis, and two clinical signs of decompensation into a simple A, B, or C category that has guided prognosis and surgical decisions for decades.

How it works

Each of five parameters is scored 1, 2, or 3:

Bilirubin (mg/dL):  <2 = 1 | 2-3 = 2 | >3 = 3
Albumin (g/dL):     >3.5 = 1 | 2.8-3.5 = 2 | <2.8 = 3
INR:                <1.7 = 1 | 1.7-2.3 = 2 | >2.3 = 3
Ascites:            none = 1 | mild = 2 | moderate-severe = 3
Encephalopathy:     none = 1 | grade 1-2 = 2 | grade 3-4 = 3

The five points are summed:

5-6   = Class A
7-9   = Class B
10-15 = Class C

Worked example

A patient with bilirubin 1.5 mg/dL (1 point), albumin 3.0 g/dL (2 points), INR 1.5 (1 point), mild ascites (2 points), and no encephalopathy (1 point) scores 7 total — Class B. They have compensated-to-borderline disease with meaningful functional compromise.

What each class means clinically

Class A (5–6 points): well-compensated

Patients in Child-Pugh A have near-normal synthetic function and no or minimal clinical decompensation. They can generally tolerate major surgery, including hepatic resection of lesions, provided the future remnant liver volume is adequate. Estimated one-year survival is roughly 95–100%.

Class B (7–9 points): significant functional compromise

Class B indicates important impairment of synthetic and excretory function, often with ascites that requires diuretics or paracentesis. Elective major surgery carries substantially elevated mortality risk; operative decisions require careful multidisciplinary review. Estimated one-year survival is around 80%.

Class C (10–15 points): decompensated disease

Class C represents advanced failure of hepatic reserve with severe coagulopathy, refractory ascites, and often recurrent encephalopathy. Elective major surgery is generally contraindicated. Class C patients should typically be evaluated for liver transplantation rather than hepatic resection. Estimated one-year survival is around 45%.

Child-Pugh versus MELD

Both scores predict mortality in cirrhosis, but they serve slightly different roles in clinical practice:

Feature	Child-Pugh	MELD
Inputs	3 labs + 2 clinical signs	3 labs only (creatinine, bilirubin, INR)
Output	Category (A/B/C)	Continuous score
Subjectivity	Ascites and encephalopathy grading	Minimal
Primary use	Surgical risk, bedside staging	Transplant organ allocation

Child-Pugh’s use of clinical signs introduces inter-observer variability, but it also captures information — ascites status and encephalopathy grade — that is directly relevant to perioperative risk. MELD, being entirely lab-based, is more reproducible but may miss some clinically relevant dimensions of decompensation. Most hepatology services use both rather than one or the other.

Documentation note

The two clinical inputs (ascites, encephalopathy) should be graded and documented at the time of the assessment, along with the basis for the grade (clinical examination, imaging, response to lactulose, etc.). This is important both for reproducibility and for medico-legal purposes when the score is used in surgical risk communication.