Child Pugh Score Calculator

The Child-Pugh score compresses five markers of liver failure into a single figure between 5 and 15. Two are synthetic: serum albumin, which falls as hepatocyte production declines, and INR, which reflects the failing liver inability to make clotting factors II, VII, IX and X. One is excretory, total bilirubin. Two are clinical consequences of portal hypertension and portosystemic shunting, ascites and hepatic encephalopathy. Each is scored 1, 2 or 3. 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. Class A is 5 to 6 points, class B 7 to 9, class C 10 to 15. The classes carry concrete prognostic weight. One-year survival is near 100 percent in class A, roughly 80 percent in class B and about 45 percent in class C, while perioperative mortality for abdominal surgery climbs from around 10 percent to 30 percent to well over 70 percent across the same classes. The score also informs drug dosing labels and eligibility for procedures such as TIPS. Its weaknesses are well documented: ascites and encephalopathy are graded subjectively and vary between observers, the laboratory cut-offs are arbitrary steps applied to continuous variables, renal function is ignored entirely, and both albumin and INR can be distorted by albumin infusion or anticoagulant therapy. A score of 7 and a score of 9 share a class despite meaningfully different outcomes.

The score began as a surgical triage tool rather than a prognostic index. In 1964 Charles Gardner Child and Jeremiah Turcotte, at the University of Michigan, published Surgery and Portal Hypertension, in which they sorted patients with cirrhosis into groups A, B and C to predict who would survive portacaval shunt surgery. Their original grouping used bilirubin, albumin, ascites, neurological disorder and nutritional status, the last judged simply as excellent, good or poor, which made it impossible to reproduce between observers. In 1973 Robert Pugh and colleagues at King's College Hospital in London, reporting on transection of the esophagus for bleeding varices, replaced the vague nutritional category with prothrombin time, an objective measurement, and applied a numerical 1 to 3 point system to every variable. That modification produced the 5 to 15 point Child-Turcotte-Pugh score in use today, with INR later substituted for prothrombin time to standardize results across laboratories. The score dominated liver disease staging for three decades until February 2002, when the United Network for Organ Sharing adopted MELD for deceased donor liver allocation in the United States, largely because MELD is continuous and contains no subjective variables. Child-Pugh nonetheless remains standard in surgical risk assessment, drug labeling and clinical trial entry criteria.