The Child-Pugh scoring system estimates the severity of chronic liver disease, particularly cirrhosis. It assigns points for five clinical variables: total bilirubin, serum albumin, international normalized ratio (INR), ascites, and hepatic encephalopathy. The resulting total categorizes liver function into class A, B, or C, which physicians use to estimate prognosis and determine management strategies. Because liver disease impacts multiple organ systems, a single measurement rarely captures the full picture. By combining laboratory values with clinical observations, the Child-Pugh score helps stratify risk for complications such as variceal bleeding and hepatic failure.
Bilirubin reflects how well the liver excretes bile. Albumin represents the liver’s ability to synthesize proteins. INR measures blood clotting time, which lengthens as liver function declines. Ascites, the buildup of fluid in the abdomen, signals portal hypertension. Hepatic encephalopathy indicates buildup of toxins in the brain and can range from subtle confusion to coma. Each variable receives between one and three points depending on severity. A typical scoring approach is:
| Measure | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Bilirubin | <2 mg/dL | 2–3 mg/dL | >3 mg/dL |
| Albumin | >3.5 g/dL | 2.8–3.5 g/dL | <2.8 g/dL |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | None | Mild | Moderate–Severe |
| Encephalopathy | None | Grades 1–2 | Grades 3–4 |
Points from all five categories are summed. Scores of 5–6 fall into Child-Pugh class A, indicating well-compensated disease. A total of 7–9 corresponds to class B, suggesting significant functional compromise but potential for aggressive therapy. Scores between 10 and 15 constitute class C, reflecting decompensated cirrhosis and a poorer prognosis. In transplant evaluation, class C patients are generally prioritized. The Child-Pugh score also assists with medication dosing and predicting surgical outcomes.
Although developed decades ago, the Child-Pugh system remains a core component of hepatology practice. Surgeons assess surgical risk by considering whether a patient’s liver can withstand anesthesia and metabolic stress. Oncologists weigh options for liver cancer treatment by analyzing underlying function. Gastroenterologists use the score to guide portal hypertension management. Even with advanced imaging and newer scores such as MELD, the Child-Pugh classification offers straightforward, bedside applicability.
As with any clinical tool, the Child-Pugh score has limitations. Its ascites and encephalopathy assessments are somewhat subjective. Two clinicians might grade mild encephalopathy differently. Additionally, the score was developed from patients with alcoholic cirrhosis, so accuracy may vary in other etiologies like viral hepatitis or nonalcoholic fatty liver disease. It also does not account for renal function or sodium levels, which more recent systems incorporate.
This online tool speeds up the scoring process. By selecting values and categories, you see the calculated total instantly without referencing a table. The code mirrors the standard scoring criteria to output both the numerical result and corresponding class. Clinicians can double-check their bedside assessments, while students can practice calculating scores as part of their training. Remember that no tool replaces professional judgment.
Each input is converted to a numeric point value. Bilirubin, albumin, and INR thresholds create ranges that map to 1, 2, or 3. The ascites and encephalopathy drop-downs also return 1, 2, or 3. The sum is then classified. Mathematically this is expressed as where each letter represents the points for that category.
A score alone cannot capture all nuances of liver disease. Still, it provides a reliable snapshot of overall function. Discuss any concerning results with your healthcare provider, who can interpret them in the context of imaging, symptoms, and other labs. Early intervention—whether lifestyle changes, medications, or even evaluation for transplant—can slow progression and improve quality of life.
Chronic liver conditions can be complex and frightening, but tools like the Child-Pugh score help demystify the risks. By quantifying disease severity, clinicians and patients can plan treatments more effectively. Use this calculator to understand where you stand today, then work with your medical team to protect your liver health for the future.
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