Child-Pugh Calculator
Calculate Child-Pugh score to assess liver disease severity and estimate prognosis based on clinical and lab values.
What Is the Child-Pugh Score?
The Child-Pugh score is a clinical tool used to assess the severity of chronic liver disease, primarily cirrhosis. It combines five clinical and laboratory measures to classify liver function into three prognostic categories. The score helps clinicians estimate short-term survival, surgical risk, and the need for liver transplantation.
How the Score Is Calculated
The Child-Pugh score assigns points based on five parameters. Each parameter receives a score of 1, 2, or 3, with 3 indicating the most severe impairment.
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Total bilirubin (mg/dL) | < 2.0 | 2.0 – 3.0 | > 3.0 |
| Serum albumin (g/dL) | > 3.5 | 2.8 – 3.5 | < 2.8 |
| INR | < 1.7 | 1.7 – 2.3 | > 2.3 |
| Ascites | None | Mild / controlled | Moderate / refractory |
| Hepatic encephalopathy | None | Grade I – II | Grade III – IV |
The total score ranges from 5 to 15. The sum determines the Child-Pugh class:
- Class A (5–6 points): Compensated disease, lowest surgical risk, best prognosis.
- Class B (7–9 points): Significant functional impairment, moderate risk.
- Class C (10–15 points): Decompensated disease, highest risk, poorest prognosis.
How to Use This Calculator
Enter the patient's lab values and clinical findings into the corresponding fields. The calculator automatically sums the points and displays the Child-Pugh class. No manual scoring is required.
For ascites and encephalopathy, select the option that best matches the clinical assessment. If a parameter is unavailable, the calculator will indicate that the score may be incomplete.
Interpreting the Results
The Child-Pugh class provides a general prognosis but does not replace comprehensive clinical evaluation.
- Class A patients typically tolerate surgery well and have a one-year survival above 95%.
- Class B patients require careful preoperative optimization and have a one-year survival around 80%.
- Class C patients have a one-year survival below 50% and are often considered for liver transplantation.
The score is most reliable when all five parameters are available. Missing data may lead to underestimation or overestimation of severity.
Common Misconceptions
- The score is not a diagnostic tool. It assesses severity in patients already diagnosed with chronic liver disease.
- It does not replace MELD. For transplant prioritization, the MELD score is more commonly used.
- Acute changes can affect results. Bilirubin and INR may fluctuate during acute illness, altering the class temporarily.
Limitations
- Subjective assessment of ascites and encephalopathy introduces variability between clinicians.
- The score does not account for extrahepatic complications such as variceal bleeding or hepatorenal syndrome.
- It is less discriminative in patients with scores near class boundaries.
When to Use the Child-Pugh Score
- Preoperative risk assessment for patients with cirrhosis undergoing surgery.
- Prognostic evaluation in chronic liver disease.
- Determining candidacy for liver transplantation in conjunction with other scoring systems.
FAQ
What is the difference between Child-Pugh and MELD?
Child-Pugh classifies liver disease severity into three categories using clinical and lab parameters. MELD is a continuous score that predicts 90-day mortality and is used for transplant organ allocation. MELD is more objective and does not rely on subjective clinical findings.
Can the Child-Pugh score be used for acute liver failure?
No. The Child-Pugh score is designed for chronic liver disease and cirrhosis. Acute liver failure requires different assessment tools such as the King's College Criteria.
What if a lab value is missing?
The score is most accurate when all five parameters are available. If a value is missing, the calculator will note the incompleteness. Clinical judgment should be used to interpret the partial result.
How often should the score be recalculated?
Reassessment is appropriate when clinical status changes, before major procedures, or at regular intervals during follow-up. The score can change with disease progression or improvement.
Is the Child-Pugh score still relevant today?
Yes. Despite newer scoring systems, Child-Pugh remains widely used for surgical risk stratification and initial prognostic assessment due to its simplicity and clinical familiarity.