Child-Pugh Score Calculator

Calculate the five-component Child-Pugh score and A, B, or C classification without unsupported individual prognosis claims.

Related Liver & Gastrointestinal Calculators

Adjacent Calculators

International Normalized Ratio Calculator — Calculate INR from appropriate PT and ISI inputs separately when needed; INR is only one Child-Pugh component and cannot replace the complete five-item score.
BUN/Creatinine Ratio Calculator — Review this renal laboratory ratio separately; kidney markers are not Child-Pugh inputs and must not be substituted for the score’s hepatic variables.

Child-Pugh Score Formula

The Child-Pugh score adds five component scores. Each component contributes 1, 2, or 3 points, so the total ranges from 5 to 15.

Child-Pugh score = bilirubin points + albumin points + INR or PT points + ascites points + encephalopathy points

Bilirubin points use total bilirubin and the selected scoring method.
Albumin points use serum albumin.
Coagulation points use either INR or prothrombin-time prolongation above the matched control value, not both.
Ascites points use a clinician’s assessment of ascites.
Encephalopathy points use a clinician’s grade of hepatic encephalopathy.

The total is grouped as Class A for 5–6 points, Class B for 7–9 points, or Class C for 10–15 points. The class is a categorical summary of the five entered components. This calculator does not convert the class into an individual survival estimate, operative risk, medication dose, clinical-state label, or transplant decision.

Child-Pugh Scoring Criteria and Class Interpretation

The automatic lab-value mode uses the conventional, noncholestatic bilirubin method shown below. Values that sit exactly on a boundary are assigned according to the middle band displayed in the table.

Component	1 point	2 points	3 points
Total bilirubin (mg/dL)	Under 2	2 to 3	Over 3
Total bilirubin (µmol/L)	Under 34.2	34.2 to 51.3	Over 51.3
Serum albumin (g/dL)	Over 3.5	2.8 to 3.5	Under 2.8
Serum albumin (g/L)	Over 35	28 to 35	Under 28
INR	Under 1.7	1.7 to 2.3	Over 2.3
PT prolongation above control	Under 4 seconds	4 to 6 seconds	Over 6 seconds
Ascites	None	Slight or diuretic-responsive	Moderate or diuretic-refractory
Hepatic encephalopathy	None	Clinician grade 1 or 2	Clinician grade 3 or 4

Important bilirubin-method note: some published implementations for primary biliary cholangitis, primary sclerosing cholangitis, or another cholestatic disease substitute higher bilirubin cutpoints, commonly under 4, 4–10, and over 10 mg/dL. This calculator’s automatic lab-value mode does not apply that variant. A qualified clinician must choose the applicable method. If component points have already been established using an appropriate method, the calculator’s points mode can add them without re-scoring the laboratory values.

A score near a band boundary deserves particular care. For example, moving from INR 1.69 to 1.70 changes the coagulation component from 1 point to 2 points in this implementation even though the numerical change is small. That is a feature of categorical scoring, not evidence of an abrupt biological change.

How to Use the Child-Pugh Calculator

Confirm that a clinician has selected Child-Pugh as an appropriate classification for the clinical setting and has graded ascites and hepatic encephalopathy.
Select Enter laboratory values to use the conventional automatic thresholds, or select Enter established component points if the three laboratory-component scores are already known.
In laboratory mode, enter total bilirubin, serum albumin, and either INR or PT prolongation above control. Choose the unit printed on the report.
Select the clinician-assigned ascites and encephalopathy categories. Do not infer these categories from a laboratory report alone.
Select Calculate and review every component point, the total, and the A, B, or C class. Confirm that the selected bilirubin method and coagulation measure match the source data.

Example Problems

Example 1: Enter Conventional Laboratory Values

Consider an example with total bilirubin 2.5 mg/dL, albumin 3.1 g/dL, INR 1.8, clinician-graded slight ascites, and no hepatic encephalopathy.

Bilirubin 2.5 mg/dL = 2 points
Albumin 3.1 g/dL = 2 points
INR 1.8 = 2 points
Slight ascites = 2 points
No encephalopathy = 1 point

Total = 2 + 2 + 2 + 2 + 1 = 9 points = Class B

The result is a 9-point Class B classification. It does not provide an individualized outcome estimate or treatment instruction.

Example 2: Add Established Component Points

Suppose a clinician has already assigned bilirubin 1 point, albumin 2 points, coagulation 1 point, ascites 1 point, and encephalopathy 1 point using the appropriate method.

Total = 1 + 2 + 1 + 1 + 1 = 6 points = Class A

Points mode performs only this addition. It does not verify whether the clinician’s underlying grades or method were appropriate.

Interpretation, Scope, and Limitations

The score’s modern form is associated with the 1973 Pugh and colleagues paper on esophageal transection for bleeding esophageal varices. Its later use has extended far beyond that original surgical context, but the historical origin matters: a three-band classification should not be treated as a precise forecast for every individual or every clinical question.

Two components require clinical judgment. Ascites and hepatic encephalopathy are not values that a web form can independently diagnose or grade. Treatment can also affect their apparent category.
The laboratory components are not liver-exclusive. Bilirubin, albumin, and coagulation results may be affected by conditions, medications, nutrition, or measurement circumstances outside the score’s intended mechanism.
Different profiles can yield the same total. A 9-point score can arise from many combinations, so the component table remains clinically relevant even when the class matches.
Categorization loses detail. A large change within one 3-point band does not change the score, while a small change across a threshold can add a point.
The result is not a medication instruction. Regulators use Child-Pugh categories in some hepatic-impairment studies, but dosing depends on the specific drug’s evidence, approved labeling, interactions, and patient factors.
The result is not a transplant or surgery rule. It must not be substituted for the model, policy, specialist evaluation, or procedure-specific assessment required in those settings.

A score can be recalculated when source measurements or clinician-assigned grades change, but a change may reflect treatment, measurement timing, or reassessment as well as a change in illness. Compare like with like and retain the underlying component values.

Frequently Asked Questions

What are the lowest and highest possible Child-Pugh scores?

The lowest total is 5 because each of the five components contributes at least 1 point. The highest total is 15 because each contributes no more than 3 points.

Can I grade ascites or encephalopathy myself?

No. They are clinical assessments that require a qualified clinician and the relevant history and examination. Selecting a category without that assessment can change the total and class incorrectly.

Why does this calculator disclose a noncholestatic bilirubin method?

Because some cholestatic-disease implementations use different bilirubin thresholds. The distinction can change the bilirubin point assignment. The automatic mode uses only the conventional thresholds displayed on this page.

Can Child-Pugh class determine a drug dose?

No. Some product labels refer to Child-Pugh categories, while others use different evidence or give no class-based adjustment. Use the current label and a prescribing clinician or pharmacist; do not transfer a rule from one drug to another.

Is Child-Pugh the same as MELD?

No. They use different inputs, mathematical structures, and intended applications. Child-Pugh combines three laboratory components with two clinician-graded findings and produces three classes. The scores are not interchangeable.

Can two people in the same class have different clinical situations?

Yes. Different combinations of bilirubin, albumin, coagulation, ascites, and encephalopathy can lead to the same total. The class should always be reviewed with its component breakdown and the complete clinical assessment.