This Child-Pugh calculator scores cirrhosis severity across five measures — bilirubin, albumin, INR, ascites and encephalopathy — into Class A, B or C, the classification that has framed liver prognosis since 1973.

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Five Measures, 1–3 Points Each: 5–6 = A, 7–9 = B, 10–15 = C

Child-Pugh mixes labs with bedside findings (ascites, encephalopathy) that no blood test captures — its subjectivity is also its humanity. The lab-only successor runs on our MELD Calculator. Part of our Health Calculators collection.

Worked Examples (Verified)

  • Bilirubin 1.5 (1 pt), albumin 3.2 (2), INR 1.5 (1), no ascites (1), no encephalopathy (1) (defaults): total 6 → Class A — compensated cirrhosis, the class where elective surgery risk is lowest and surveillance is the main work
  • Full-house severity: bilirubin 3.5 (3), albumin 2.5 (3), INR 2.5 (3), refractory ascites (3), grade III encephalopathy (3) = 15 → Class C, the maximum
  • One-point cliffs are everywhere: albumin 3.5 vs 3.6 flips a point — scores near class boundaries deserve humility, not false precision
  • The surgical heritage: Child-Pugh began as operative risk stratification for portosystemic shunts, then colonized all of hepatology

The Five Components

  • Bilirubin < 2 / 2–3 / > 3 mg/dL (higher bands in cholestatic disease) — excretion failing.
  • Albumin > 3.5 / 2.8–3.5 / < 2.8 g/dL — synthesis failing (and nutrition/inflammation confound).
  • INR < 1.7 / 1.7–2.3 / > 2.3 — clotting-factor synthesis (the “auto-anticoagulated” cirrhotic is a myth; rebalanced hemostasis is real).
  • Ascites and encephalopathy — graded clinically, the two subjective inputs critics cite and clinicians refuse to surrender.

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Frequently Asked Questions

How is the Child-Pugh score calculated?

Score five items 1–3 points each: bilirubin (<2 / 2–3 / >3 mg/dL), albumin (>3.5 / 2.8–3.5 / <2.8 g/dL), INR (<1.7 / 1.7–2.3 / >2.3), ascites (none / mild / refractory) and encephalopathy (none / grade I–II / III–IV). Totals: 5–6 Class A, 7–9 Class B, 10–15 Class C.

What do Child-Pugh classes mean for survival?

In the original series: Class A ≈ 100% 1-year and 85% 2-year survival; Class B ≈ 81% / 57%; Class C ≈ 45% / 35%. Modern therapy (antivirals, TIPS, transplant, HCC care) has shifted each band, but the ordering remains a sturdy shorthand for hepatic reserve.

Child-Pugh vs MELD — which is used now?

Both: MELD (now MELD 3.0) drives organ allocation for its objectivity; Child-Pugh persists in drug dosing references (many labels specify A/B/C adjustments), surgical risk talk, and bedside communication. They correlate well; discrepancies usually trace to Child-Pugh’s clinical signs or MELD’s creatinine weight.

Why are ascites and encephalopathy subjective?

They’re clinical gradings without lab meters — “mild vs refractory” ascites and West Haven encephalopathy grades depend on examination and history. That’s Child-Pugh’s known weakness and its unique strength: it sees the patient, not just the panel.

Does Child-Pugh differ in cholestatic liver disease?

Yes — for primary biliary cholangitis and PSC, bilirubin points use higher thresholds (< 4 mg/dL = 1, 4–10 = 2, > 10 = 3) because bilirubin runs disproportionately high in cholestasis relative to overall liver function. This calculator uses the standard bands and flags the exception.

Is this Child-Pugh calculator free?

Yes — free, instant, no sign-up. An educational aid; prognostic discussions belong with the hepatology team.