Child Pugh Score Calculator
Classify the severity of chronic liver disease using the Child-Pugh classification. Enter values for instant results with step-by-step formulas.
Formula
Child-Pugh Score = Bilirubin + Albumin + INR + Ascites + Encephalopathy (each 1-3 pts)
Five clinical parameters are each scored 1-3 points. Total ranges from 5 to 15. Class A: 5-6 (well-compensated), Class B: 7-9 (significant compromise), Class C: 10-15 (decompensated).
Worked Examples
Example 1: Mild Cirrhosis Assessment
Problem: Patient has bilirubin 1.5 mg/dL, albumin 3.8 g/dL, INR 1.2, no ascites, no encephalopathy.
Solution: Bilirubin 1.5 (< 2): 1 point\nAlbumin 3.8 (> 3.5): 1 point\nINR 1.2 (< 1.7): 1 point\nAscites none: 1 point\nEncephalopathy none: 1 point\nTotal = 5 points
Result: Child-Pugh Score: 5, Class A - Well-compensated disease. 1-year survival: ~100%.
Example 2: Advanced Cirrhosis with Complications
Problem: Patient has bilirubin 4.2 mg/dL, albumin 2.5 g/dL, INR 2.5, moderate ascites, grade III encephalopathy.
Solution: Bilirubin 4.2 (> 3): 3 points\nAlbumin 2.5 (< 2.8): 3 points\nINR 2.5 (> 2.3): 3 points\nAscites moderate/severe: 3 points\nEncephalopathy grade III-IV: 3 points\nTotal = 15 points
Result: Child-Pugh Score: 15, Class C - Decompensated disease. 1-year survival: ~45%.
Frequently Asked Questions
What is the Child-Pugh score and what is it used for?
The Child-Pugh score (also called the Child-Turcotte-Pugh or CTP score) is a clinical classification system used to assess the severity of chronic liver disease, particularly cirrhosis. Originally developed by Child and Turcotte in 1964 and later modified by Pugh in 1973, it evaluates five clinical measures: total bilirubin, serum albumin, prothrombin time (INR), presence of ascites, and hepatic encephalopathy. Each parameter receives 1 to 3 points, yielding a total score from 5 to 15. Patients are then classified into Class A (5-6 points, well-compensated), Class B (7-9 points, significant compromise), or Class C (10-15 points, decompensated disease). This score guides treatment decisions and transplant evaluation.
How is each component of the Child-Pugh score graded?
Each of the five parameters is scored 1, 2, or 3 points. Bilirubin: less than 2 mg/dL scores 1 point, 2-3 mg/dL scores 2, and greater than 3 mg/dL scores 3. Albumin: greater than 3.5 g/dL scores 1, 2.8-3.5 scores 2, and less than 2.8 scores 3. INR (or prothrombin time): less than 1.7 scores 1, 1.7-2.3 scores 2, and greater than 2.3 scores 3. Ascites: absent scores 1, mild or controlled with diuretics scores 2, and moderate to severe or refractory scores 3. Hepatic encephalopathy: none scores 1, grade I-II (mild) scores 2, and grade III-IV (severe) scores 3. The sum of all five components gives the total Child-Pugh score.
What do the Child-Pugh classes mean for patient prognosis?
Child-Pugh classification provides important prognostic information for patients with chronic liver disease. Class A (5-6 points) indicates well-compensated cirrhosis with near-normal liver function, a one-year survival rate of approximately 100%, and perioperative mortality around 10%. Class B (7-9 points) represents significant functional compromise with one-year survival of 81% and perioperative mortality around 30%. Class C (10-15 points) indicates decompensated disease with one-year survival of only 45% and perioperative mortality as high as 82%. These survival estimates help clinicians determine whether patients should be listed for liver transplantation and whether they can safely undergo surgical procedures.
How does the Child-Pugh score compare to the MELD score?
Both the Child-Pugh and MELD (Model for End-Stage Liver Disease) scores assess liver disease severity, but they differ in important ways. MELD uses a continuous numerical scale (6-40) calculated from bilirubin, creatinine, and INR, making it more granular for prioritizing organ allocation. Child-Pugh includes subjective assessments of ascites and encephalopathy, which MELD does not, but this subjectivity can lead to inconsistent scoring between clinicians. MELD has largely replaced Child-Pugh for transplant allocation in the United States since 2002 because it better predicts three-month mortality and eliminates subjective components. However, Child-Pugh remains widely used in clinical trials, surgical risk assessment, and general disease staging.
What are the limitations of the Child-Pugh scoring system?
The Child-Pugh score has several recognized limitations. The subjective grading of ascites and hepatic encephalopathy introduces inter-observer variability; different clinicians may assign different scores to the same patient. The scoring system uses arbitrary cutoff values for laboratory parameters that may not reflect continuous disease severity. It does not account for renal function, which is an important predictor of outcome in advanced liver disease. The equal weighting of all five parameters may not reflect their true prognostic importance. Additionally, the three-class system (A, B, C) groups patients with different prognoses into the same category. For example, a patient with score 7 and one with score 9 are both Class B but may have significantly different outcomes.
How accurate are the results from Child Pugh Score Calculator?
All calculations use established mathematical formulas and are performed with high-precision arithmetic. Results are accurate to the precision shown. For critical decisions in finance, medicine, or engineering, always verify results with a qualified professional.