Child-Pugh Score Calculator

Evidence-based tool for assessing hepatic functional reserve, predicting surgical risk, and guiding therapy in patients with cirrhosis.

Convert μmol/L ÷ 17.1 → mg/dL
Compensated cirrhosis (Child A)
Decompensated (Child B/C)
Severe hepatic failure (Child C)
Alcoholic cirrhosis with ascites
Clinical decision support: This tool is intended for medical professionals and educational use. Always correlate with clinical judgment. Data processed locally – no patient information is stored or transmitted.

Understanding the Child-Pugh Score

Originally published by Child and Turcotte in 1964 and later modified by Pugh et al., the Child-Pugh score (Child-Turcotte-Pugh, CTP) remains a cornerstone prognostic tool for chronic liver disease and cirrhosis. It quantifies hepatic synthetic function, portal hypertension complications, and encephalopathy. The score stratifies patients into class A (5–6 points), B (7–9 points), or C (10–15 points), correlating with disease severity, perioperative mortality, and transplant prioritization.

Clinical validation & guidelines: The CTP score is endorsed by the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) for assessing prognosis in cirrhosis, predicting outcomes after TIPS, liver resection, and variceal bleeding. It complements the MELD score but retains unique utility in surgical risk stratification.

Score Components & Parameter Ranges

Parameter1 point2 points3 points
Total Bilirubin (mg/dL)<22–3>3
Serum Albumin (g/dL)>3.52.8–3.5<2.8
PT prolongation (sec) / INR<4 / INR<1.74–6 / INR 1.7-2.2>6 / INR>2.2
AscitesNoneMild (diuretic responsive)Moderate–severe / refractory
Hepatic EncephalopathyNoneGrade I–II (mild)Grade III–IV (severe)

Clinical Interpretation & Prognosis

  • Child-Pugh class A (5–6 points): Well-compensated liver disease. 1-year survival ≈ 95–100%, 2-year survival ≈ 85–90%. Low risk for hepatic decompensation. Candidates for elective surgery with careful monitoring.
  • Child-Pugh class B (7–9 points): Significant functional compromise. 1-year survival ~80%, 2-year survival ~60-70%. Moderate risk for postoperative complications; often require optimization before interventions.
  • Child-Pugh class C (10–15 points): Decompensated cirrhosis, poor prognosis. 1-year survival ~45-50%. Listed for liver transplantation evaluation. High surgical mortality and frequent complications.
References: Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649. | D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis. J Hepatol. 2006;44(1):217-231.
Clinical Case Example: Preoperative Risk Assessment

A 58-year-old with alcoholic cirrhosis and ascites (moderate, responsive to diuretics) presents for umbilical hernia repair. Bilirubin: 2.4 mg/dL (2 pts), Albumin: 2.9 g/dL (2 pts), INR: 1.8 (2 pts), Ascites: moderate (2 pts), Encephalopathy: grade 1 (2 pts). Total = 10 points → Child-Pugh class C. Recommendation: optimize with diuretics, consider TIPS evaluation, delay elective surgery due to high risk of decompensation. This calculator provides immediate data-driven guidance, empowering hepatology teams.

Frequently Asked Questions (FAQs)

MELD score uses creatinine, bilirubin, INR and is preferred for prioritizing liver transplantation (higher dynamic range). Child-Pugh incorporates subjective variables (ascites, encephalopathy) and remains excellent for surgical risk assessment, especially in cirrhotic patients undergoing non-hepatic surgery.

Yes. Our calculator uses the equivalency: INR <1.7 → 1 point, INR 1.7–2.2 → 2 points, INR >2.2 → 3 points. This aligns with current hepatology practice.

Patients with Child-Pugh class C >13 points are generally poor candidates for TIPS due to high post-procedural mortality. Classes A and B have more favorable outcomes. This scoring system helps guide procedural decision-making.

The score was developed for chronic liver disease. In acute liver failure, other prognostic scores (KCH, MELD) are more appropriate. The CTP score is not validated for acute presentations.

Clinically stable cirrhotics may be reassessed every 6–12 months. Decompensating events or therapy modifications (TIPS, albumin infusion, diuretics) warrant repeat scoring.

Evidence-based medicine commitment: This Child-Pugh calculator was developed and peer-reviewed by getzenquery tech team, ensuring alignment with AASLD/EASL guidelines (June 2026). Regular updates are made to reflect latest prognostic evidence. For any clinical queries, please consult local specialist.