Child-Pugh Score Calculator

What the Child-Pugh Score Measures

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.

Scoring Criteria

Bilirubin reflects how well the liver excretes bile. Albumin measures synthetic function. INR indicates clotting ability. Ascites reveals the degree of portal hypertension, while encephalopathy highlights toxin buildup affecting the brain. Each variable receives between one and three points depending on severity. The standard thresholds appear below.

Point assignment for each Child-Pugh criterion

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	Grade 1–2	Grade 3–4

Understanding the Formula

Each input is converted to a numeric point value. The calculator then adds the five components to produce the total. In MathML form, the score is expressed as

where the letters correspond to the point values assigned for bilirubin, albumin, INR, ascites, and encephalopathy respectively. Totals of 5–6 equal Child-Pugh class A, 7–9 correspond to class B, and 10–15 align with class C.

Sample Patient Scenarios

The table below illustrates how different combinations of findings map to overall Child-Pugh classifications. All laboratory values are in the units required by the score.

Example Child-Pugh scenarios

Scenario	Inputs	Score	Class
Compensated outpatient	Bilirubin 1.4, albumin 3.6, INR 1.3, no ascites, no encephalopathy	5	A
Moderate decompensation	Bilirubin 2.6, albumin 3.0, INR 1.9, mild ascites, grade 1 encephalopathy	8	B
Advanced liver failure	Bilirubin 4.1, albumin 2.4, INR 2.6, tense ascites, grade 3 encephalopathy	13	C

Clinical Use Cases

Although developed decades ago, the Child-Pugh system remains a core component of hepatology practice. Surgeons assess operative risk, oncologists weigh treatment options, and gastroenterologists guide portal hypertension management using the classification. Even with advanced imaging and newer scores such as MELD, the Child-Pugh classification offers straightforward, bedside applicability.

Limitations

As with any clinical tool, the Child-Pugh score has limitations. Its ascites and encephalopathy assessments are somewhat subjective, and the score was developed from patients with alcoholic cirrhosis. It does not directly account for renal function or sodium levels, which more recent systems incorporate. Treat the result as a component of a broader evaluation rather than a standalone diagnosis.

Plan Next Steps

Use this calculator alongside the MELD Score Calculator, FIB-4 Liver Fibrosis Calculator, and eGFR Calculator to build a comprehensive picture of liver and renal health.