Child-Pugh Score Calculator

The Child-Pugh (also written Child-Turcotte-Pugh) score is a decades-old, widely used clinical tool for grading the severity of chronic liver disease and cirrhosis. Child and Turcotte first described a version in 1964 to help select candidates for portal-decompression surgery, and Pugh and colleagues modified it in 1973 -- swapping in prothrombin time (the precursor to today's INR) for the original nutritional-status criterion -- giving the score the five-parameter form still used today. It is still routinely used to estimate prognosis and surgical risk even though MELD-based scores have taken over primary responsibility for US liver transplant allocation -- MELD-Na from 2016 until OPTN's July 2023 switch to MELD 3.0, which is the score actually driving waitlist priority now. Five clinical measures are each scored 1 to 3 points -- three from lab values (total bilirubin, serum albumin, and INR, a measure of clotting derived from prothrombin time) and two from clinical assessment (the presence and severity of ascites, or fluid in the abdomen, and hepatic encephalopathy, or liver-related confusion) -- using published cutoffs, so every parameter contributes an equal 1-3 point range regardless of which one is driving the abnormality.

The five point totals are summed for a total score from 5 to 15, which sorts patients into three severity classes: Class A (5-6 points, well-compensated liver disease), Class B (7-9 points, significant functional impairment), and Class C (10-15 points, decompensated disease). Approximate survival and perioperative mortality figures shown alongside the score are commonly cited literature estimates associated with each class rather than a precise formula computed from the score itself, and they vary somewhat between published cohorts -- treat them as an order-of-magnitude prognostic guide, not a specific percentage for an individual patient. Because all five components carry the same 1-3 point weight, no single lab value or clinical finding predictably outweighs the others -- a patient can reach Class C through severe derangement in any combination of the five, which is part of why the score remains useful as a quick composite even though it is coarser than more continuous scores like MELD-Na.