What is the main difference between Child-Pugh and MELD score?

Child-Pugh uses subjective items (ascites, encephalopathy) and classifies cirrhosis into Class A, B, or C for general prognosis and surgical risk. MELD uses purely objective laboratory tests (Cr, Bili, INR, Na) and is used for liver transplant allocation.

Is elective surgery safe in Child-Pugh Class C?

No. Elective surgery is strongly contraindicated in Child-Pugh Class C due to 70–80% perioperative mortality. Optimization or transplant evaluation is required.

Medically Reviewed · CliniqWise Clinical Advisory Board — Gastroenterology & Hepatology Panel · Updated 2026-08-27

Child-Pugh Score Calculator — Liver Cirrhosis Severity & Surgical Risk Classification

Calculate the Child-Pugh score (Child-Turcotte-Pugh) to grade chronic liver disease severity (Class A, B, C) and estimate 1-year and 2-year survival.

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Child-Pugh Score Calculator

Enter values below to calculate

Total Bilirubin*

Serum Albumin*

INR*

Ascites*

Hepatic Encephalopathy*

This calculator is for informational and educational purposes. Results should be interpreted with clinical judgment and local guidelines.

What is the Child-Pugh Score?

The Child-Pugh score (or Child-Turcotte-Pugh score) is a clinical scoring tool used to assess the severity of chronic liver disease, primarily cirrhosis. Originally created by Dr. Charles G. Child and Dr. Jeremiah G. Turcotte in 1964 to stratify operative mortality before portal decompression surgery, it was modified by Pugh et al. in 1973 (replacing nutritional status with prothrombin time/INR). The score uses 5 clinical and laboratory parameters: total bilirubin, serum albumin, INR, ascites, and hepatic encephalopathy. Scores range from 5 to 15, categorizing patients into Child-Pugh Class A (5–6: well-compensated), Class B (7–9: significant functional compromise), or Class C (10–15: decompensated cirrhosis).

Child-Pugh Score = Bilirubin (1–3 pts) + Albumin (1–3 pts) + INR (1–3 pts) + Ascites (1–3 pts) + Encephalopathy (1–3 pts). Range: 5–15. Class A: 5–6 (1-yr survival 100%). Class B: 7–9 (1-yr survival 80%). Class C: 10–15 (1-yr survival 45%).

When to Use the Child-Pugh Score

Prognostic staging of chronic liver disease (cirrhosis) and survival estimation.
Pre-operative surgical risk assessment in patients with cirrhosis undergoing non-cardiac surgery.
Drug dosing adjustments in hepatic impairment according to FDA/EMA regulatory guidelines.
Monitoring clinical progression and decompensation in cirrhotics.

Liver CirrhosisHepatic DecompensationPortal HypertensionPre-Operative Risk in CirrhosisHepatic Drug Dosing Adjustment

Child-Pugh Parameter Scoring Breakdown (1–3 Points Each)

Child-Pugh Total Score Formula

Child-Pugh Score = Bilirubin + Albumin + INR + Ascites + Encephalopathy

Bilirubin = 2.5 mg/dL (+2), Albumin = 3.0 g/dL (+2), INR = 1.9 (+2), Ascites = Slight (+2), Encephalopathy = None (+1) → Total Score = 9 (Class B)

Variables

Total Bilirubin (mg/dL)

1 pt: < 2.0 | 2 pts: 2.0–3.0 | 3 pts: > 3.0 (For PBC/PSC: 1 pt: < 4, 2 pts: 4–10, 3 pts: > 10)

Serum Albumin (g/dL)

1 pt: > 3.5 | 2 pts: 2.8–3.5 | 3 pts: < 2.8

INR (dimensionless)

1 pt: < 1.7 | 2 pts: 1.7–2.3 | 3 pts: > 2.3

Ascites (clinical grade)

1 pt: None | 2 pts: Mild / Slight (controlled with diuretics) | 3 pts: Moderate to Severe / Refractory

Hepatic Encephalopathy (West Haven grade)

1 pt: None | 2 pts: Grade 1–2 (mild/moderate, controlled with lactulose) | 3 pts: Grade 3–4 (severe / coma)

Max score = 15; Min score = 5.

Child-Pugh Classification & Survival Table

Correlates score with 1-year and 2-year survival as well as perioperative surgical mortality.

Range	Classification	Health Risk
5–6 points	Class A — Well-Compensated Cirrhosis	1-yr survival: 100% \| 2-yr survival: 85% \| Perioperative mortality: ~10%
7–9 points	Class B — Significant Functional Compromise	1-yr survival: 80% \| 2-yr survival: 60% \| Perioperative mortality: ~30%
10–15 points	Class C — Decompensated Cirrhosis	1-yr survival: 45% \| 2-yr survival: 35% \| Perioperative mortality: ~70–80%

Class C patients are generally contraindicated for elective major surgery due to extremely high perioperative mortality.

Limitations & Clinical Warnings

Includes subjective clinical variables (Ascites and Encephalopathy grading).

Does not include renal function (creatinine), which is captured by the MELD score.

Surgical mortality estimates are based on traditional open procedures; modern laparoscopic outcomes may differ slightly.

Medical Disclaimer

Child-Pugh provides clinical classification. Combine with MELD score for liver transplant evaluation.

References & Citations

Child CG, Turcotte JG. “Surgery and portal hypertension”. Major Problems in Clinical Surgery. 1964. 1: 1–85. PMID: 4950264
Pugh RN, Murray-Lyon IM, Dawson JL, et al.. “Transection of the oesophagus for bleeding oesophageal varices”. British Journal of Surgery. 1973. 60(8): 646–649. PMID: 4541913

Medically Reviewed

Reviewed by CliniqWise Clinical Advisory Board — Gastroenterology & Hepatology Panel · Last updated: 2026-08-27 · Next review: 2027-02-27

Frequently Asked Questions

Common Questions About Child-Pugh Score Calculator

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