What is a normal Child-Pugh score?

The lowest (best) Child-Pugh score is 5 , which means the liver is working well. A score of 5 or 6 puts a patient in Class A . There is no score below 5 because each of the five parameters has a minimum of 1 point.

What do the Child-Pugh classes mean for surgery?

Class A patients have about a 10% risk of dying from surgery. Class B patients have about a 30% risk. Class C patients have about an 82% risk. Doctors use these numbers to decide if surgery is safe or if other treatment options are better.

Can I use the Child-Pugh score if I do not have cirrhosis?

No. The Child-Pugh score is only meant for patients who have cirrhosis (chronic liver scarring). It does not apply to healthy livers or other liver conditions that have not caused cirrhosis.

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

Both scores measure liver disease severity, but they work differently. The Child-Pugh score uses five factors (bilirubin, albumin, INR, ascites, and encephalopathy) and gives a class of A, B, or C. The MELD score uses three lab values (bilirubin, INR, and creatinine) and gives a number. MELD is mainly used to rank patients on the liver transplant waiting list. Child-Pugh is used more broadly for prognosis and treatment planning.

How is ascites graded for this calculator?

Ascites is graded in three levels. Absent means no fluid in the belly (1 point). Mild to moderate means some fluid that is controlled with medicine like diuretics (2 points). Severe means a lot of fluid that does not respond to diuretics (3 points). Your doctor can check for ascites with a physical exam or an ultrasound.

How is hepatic encephalopathy graded?

Hepatic encephalopathy is graded on a scale from 0 to 4. For this calculator, None (grade 0) gets 1 point. Grade 1–2 (mild confusion, poor sleep, or personality changes) gets 2 points. Grade 3–4 (severe confusion, stupor, or coma) gets 3 points.

Can I use prothrombin time instead of INR?

The original Child-Turcotte-Pugh system used prothrombin time . The modern version uses INR because it is standardized across labs. If you only have a prothrombin time, ask your lab to convert it to INR, or use the INR value printed on your lab report.

Does the Child-Pugh score change over time?

Yes. The score can go up or down as a patient's liver disease gets worse or improves with treatment. Doctors often recalculate it at follow-up visits to track how the disease is progressing.

Why does the score range from 5 to 15 and not 0 to 15?

Because there are five parameters and each one has a minimum of 1 point . Even if every factor is at its best level, the total is still 5. The maximum is 15 when every factor scores 3 points.

How does the Child-Pugh class affect drug dosing?

A damaged liver may not break down drugs properly. Many drug labels include dose adjustments based on Child-Pugh class. Class A patients usually need no change. Class B patients may need a lower dose. Class C patients often need a much lower dose or may not be able to use certain drugs at all. Always follow your doctor's or pharmacist's guidance.

Is this calculator accurate for children?

The Child-Pugh score was designed for adults with cirrhosis. The normal ranges for bilirubin, albumin, and INR are different in children. Pediatric liver specialists use other tools to assess liver disease in kids. The word "Child" in the name refers to Dr. Child, not to young patients.

What should I do if my patient scores Class C?

A Class C score means the liver is severely damaged. These patients often need to be evaluated for a liver transplant . Elective surgery is usually avoided because the risk of death is very high (about 82%). Talk to a hepatologist or transplant team for next steps.

Health calculators

Child Pugh Calculator

Updated Jun 20, 2026 By Jehan Wadia

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