The Child-Pugh score (formally the Child-Turcotte-Pugh score) grades the severity of liver cirrhosis using five simple clinical and laboratory measures. Introduced by Pugh and colleagues in 1973 as a refinement of the earlier Child-Turcotte classification, it remains one of the most widely used tools for staging cirrhosis severity and estimating prognosis, including surgical risk in patients with liver disease.
How the Child-Pugh score works
Five parameters are each graded 1 (mildest) to 3 (most severe) points: total bilirubin, serum albumin, and INR are graded from lab thresholds, while ascites and hepatic encephalopathy are graded from clinical assessment. The five subscores are added together, so the total ranges from 5 to 15.
The total score maps to one of three classes — A (5-6), B (7-9), or C (10-15) — each associated with a different estimated survival. Unlike lab-only scores, Child-Pugh deliberately mixes objective lab values with clinical judgment calls (the severity of ascites and encephalopathy), which is both a strength — it captures decompensation that labs alone can miss — and a source of inter-observer variability.
Reading the class and survival estimate
Class A indicates well-compensated cirrhosis with the best prognosis (approximately 100% 1-year and 85% 2-year survival). Class B indicates significant functional compromise (approximately 80% 1-year and 60% 2-year survival). Class C indicates decompensated, advanced cirrhosis with the worst prognosis (approximately 45% 1-year and 35% 2-year survival). These figures are population averages from the original literature, not a prediction for any individual patient.
The Child-Pugh class is also used clinically to estimate perioperative risk for patients with cirrhosis undergoing surgery, and historically guided decisions about esophageal variceal surgery, the original context in which the score was developed.
Limits and how it should be used
Two of the five parameters — ascites and hepatic encephalopathy — are graded by clinical judgment rather than a lab value, which introduces inter-observer variability that purely lab-based scores like MELD avoid. For liver-transplant allocation decisions, MELD or MELD-Na is now preferred because it uses continuous lab values (bilirubin, creatinine, INR, and sodium) and stratifies risk more precisely at the high-acuity end of the spectrum. Child-Pugh nonetheless remains widely used for general cirrhosis severity staging, treatment eligibility decisions, and communicating prognosis in everyday clinical practice.
This calculator is for education and clinical decision support only. It does not replace a physician's complete assessment of the patient and should not be the sole basis for prognosis, transplant-listing, or treatment decisions.