Health calculators

Child Pugh Calculator

Updated Sep 4, 2026 By Jehan Wadia
Rate Formulas Sources Medical disclaimer
Parameters selected: 5 of 5 Current Score: 7 / 15
Total Bilirubin Elevated bilirubin reflects impaired hepatic excretion.
Albumin Low albumin indicates reduced hepatic synthetic function.
Prothrombin Time / INR Reflects coagulopathy due to reduced hepatic clotting factor synthesis.
Ascites Presence and treatability of abdominal fluid accumulation.
Hepatic Encephalopathy Degree of hepatic encephalopathy based on clinical grading.
Class B
Significant functional compromise
Total Score
7 / 15
Child-Pugh Class
B
Mortality After Abdominal Surgery
30%
Score Position
Where the total score (5–15) falls across the Child-Pugh classification bands.
Score Breakdown
Parameter Selected Points
Total Score 7
Step-by-Step Solution
Point Contribution by Parameter

Introduction

The Child-Pugh score is a tool doctors use to check how well the liver is working in people with liver disease. It looks at five things: bilirubin level, albumin level, INR (how fast the blood clots), ascites (fluid in the belly), and hepatic encephalopathy (confusion caused by a sick liver). Each one gets 1, 2, or 3 points. The total score ranges from 5 to 15 and places the patient into Class A, B, or C.1 Class A means the liver still works fairly well. Class C means the liver is in serious trouble.

Doctors use the Child-Pugh classification to estimate life expectancy, judge surgical risk, and guide treatment decisions for conditions like cirrhosis. It is one of the most widely used liver disease scoring systems in hepatology.

This Child-Pugh calculator lets you pick the value for each of the five parameters and gives you the total score, the class, and a full breakdown of the results. It also shows the step-by-step math and a chart so you can see how each parameter adds to the final score.

How to Use Our Child-Pugh Calculator

Enter five lab values and clinical findings below. The calculator will give you a Child-Pugh score, class (A, B, or C), estimated life expectancy, and perioperative mortality risk.

Total Bilirubin: Pick the range that matches your patient's total bilirubin level. This measures how well the liver clears bile from the blood.

Albumin: Pick the range that matches the patient's serum albumin level. Low albumin means the liver is not making enough protein.

Prothrombin Time / INR: Pick the range that matches the patient's INR value. A high INR means the liver is not making enough clotting factors.

Ascites: Choose whether the patient has no fluid in the belly, mild to moderate fluid that responds to diuretics, or severe fluid that does not respond to diuretics.

Hepatic Encephalopathy: Choose the patient's level of brain function changes caused by liver disease. Options are none, grade 1–2 (mild to moderate confusion), or grade 3–4 (severe confusion or coma).

Once all five fields are filled in, press Calculate Score to see the full results. Press Reset Calculator to clear all selections and start over.

What Is the Child-Pugh Score?

The Child-Pugh score is a tool doctors use to measure how well or poorly the liver is working in people with chronic liver disease, also called cirrhosis. It was created by doctors C.G. Child and J.G. Turcotte in 1964 and later updated by R.N. Pugh in 1973. Today, it is one of the most common scoring systems used in hepatology, the branch of medicine that focuses on the liver.

How Does It Work?

The score looks at five factors that tell doctors about liver health. Each factor gets 1, 2, or 3 points based on how severe the problem is:

  • Total Bilirubin – A waste product the liver removes from the blood. High levels mean the liver is struggling to do its job.
  • Albumin – A protein made by the liver. Low levels show the liver is not making enough protein.
  • INR (Prothrombin Time) – A test that checks how fast the blood clots. A high INR means the liver is not making enough clotting factors.
  • Ascites – A buildup of fluid in the belly. It can be absent, mild, or severe and hard to treat.
  • Hepatic Encephalopathy – Confusion or brain fog caused by toxins the damaged liver can no longer filter out.

The five scores are added together. The total ranges from 5 (best) to 15 (worst). Doctors often evaluate additional liver-related lab markers such as the AST/ALT ratio alongside the Child-Pugh score to get a more complete picture of liver health.

What Do the Classes Mean?

The total score places a patient into one of three classes:

  • Class A (5–6 points) – The liver still works well. This is called well-compensated liver disease. After abdominal surgery, Child class A patients have a 10% mortality rate, and they are generally considered safe candidates for elective surgery.1
  • Class B (7–9 points) – The liver shows clear signs of damage. Child class B patients have a 30% mortality rate after abdominal surgery.1
  • Class C (10–15 points) – The liver is severely damaged, known as decompensated liver disease. Child class C patients have a 70 to 80% mortality rate after abdominal surgery.1

Why Is It Important?

Doctors use the Child-Pugh score to make key decisions. It helps them decide if a patient is safe enough for surgery, how to adjust drug doses that the liver must process, and whether a patient should be referred for a liver transplant. It is also used alongside other scores like the MELD score to rank patients on transplant waiting lists.

Important Limitations

The Child-Pugh score is helpful, but it is not perfect. Two of the five factors (ascites and hepatic encephalopathy) are judged by a doctor's opinion rather than a lab test, so different doctors may score them differently. The score also does not account for kidney function, which can matter a lot in advanced liver disease. For these reasons, doctors often use the Child-Pugh score together with other tools and tests to get the full picture.

Note: This calculator is for educational purposes only. It does not replace the advice of a qualified medical professional. Always talk to your doctor about your lab results and treatment options.

Formulas used

Child-Pugh Total Score 1
\text{Score} = P_{\text{Bilirubin}} + P_{\text{Albumin}} + P_{\text{INR}} + P_{\text{Ascites}} + P_{\text{Encephalopathy}}
Child-Pugh Classification 1
\text{Class} = \begin{cases} A & \text{if } 5 \le \text{Score} \le 6 \\ B & \text{if } 7 \le \text{Score} \le 9 \\ C & \text{if } 10 \le \text{Score} \le 15 \end{cases}

Frequently asked questions

What is a normal Child-Pugh score?

The lowest possible Child-Pugh score is 5, which means each of the five parameters scored 1 point. A score of 5 or 6 is Class A and is the best result. It means the liver is still working well. There is no score below 5 because every parameter starts at 1 point.

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

Both scores measure liver disease severity, but they use different inputs. The Child-Pugh score uses five factors including two clinical judgments (ascites and encephalopathy). The MELD score uses three lab values: bilirubin, INR, and creatinine. MELD is mainly used to rank patients on the liver transplant waiting list, while Child-Pugh is used more broadly to guide treatment and estimate surgical risk.

How often should the Child-Pugh score be recalculated?

Doctors usually recalculate the score whenever new lab work is done or when a patient's condition changes. For people with stable cirrhosis, this may be every 3 to 6 months. For hospitalized patients or those getting worse, it may be checked more often.

Can the Child-Pugh class change over time?

Yes. The class can get worse if the liver disease progresses. It can also improve if the cause of liver damage is treated. For example, a patient who stops drinking alcohol or gets treated for hepatitis may see their score drop and move from Class B to Class A.

Why does the score start at 5 instead of 0?

The score starts at 5 because there are five parameters and each one has a minimum value of 1 point. Even a perfectly healthy liver gets 1 point per parameter. So the lowest total is 1 + 1 + 1 + 1 + 1 = 5.

Is INR the same as prothrombin time?

They are related but not the same. Prothrombin time (PT) measures how many seconds it takes blood to clot. INR is a standardized version of PT that adjusts for differences between labs. This calculator uses INR values because they are more consistent across hospitals.

What does perioperative mortality mean in the results?

Perioperative mortality is the chance of dying during or shortly after surgery. Class A patients have about a 10% risk and Class B about 30%, and Class C 70 to 80%.1 Surgeons use these numbers to decide if an operation is safe for a patient with liver disease.

What if I do not know my ascites or encephalopathy grade?

These two parameters require a clinical exam by a doctor. If you are unsure, do not guess. Ask your doctor to assess you. Picking the wrong option can change the final class and lead to incorrect conclusions about liver function.

Can children use the Child-Pugh score?

The Child-Pugh score was designed for adults with cirrhosis. It is not validated for use in children. Pediatric liver disease is assessed using different tools. The word "Child" in the name refers to Dr. C.G. Child, one of the creators, not to young patients.

What liver conditions is the Child-Pugh score used for?

It is mainly used for chronic liver disease and cirrhosis, no matter what caused it. Common causes include alcohol-related liver disease, hepatitis B, hepatitis C, and nonalcoholic fatty liver disease. It is not meant for acute liver failure in a person who had a healthy liver before.

Sources

  1. Tsoris A, Marlar CA. Use of the Child Pugh Score in Liver Disease. StatPearls. StatPearls Publishing, NCBI Bookshelf. Accessed September 3, 2026.

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