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General
Demonstration data

Child-Pugh Score

Grades severity of chronic liver disease (cirrhosis) from bilirubin, albumin, INR, ascites and encephalopathy.

The Child-Pugh (Child-Turcotte-Pugh) score stratifies the severity and prognosis of cirrhosis using two laboratory synthetic-function markers, a coagulation marker and two clinical findings. It guides operative risk assessment and, historically, transplant prioritisation.

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📐 Formula

Score = sum of five 1-3 point items → Class A (5-6), B (7-9), C (10-15)

When to Use

  • Assessing prognosis and operative risk in a patient with established cirrhosis.
  • Contextualising imaging findings of portal hypertension, ascites or varices.
  • Serial follow-up of chronic liver disease severity.

How It Works

  • Each of five variables is scored 1, 2 or 3 points by increasing abnormality.
  • Total bilirubin: <2 = 1, 2-3 = 2, >3 mg/dL = 3.
  • Albumin: >3.5 = 1, 2.8-3.5 = 2, <2.8 g/dL = 3.
  • INR: <1.7 = 1, 1.7-2.3 = 2, >2.3 = 3.
  • Ascites: none = 1, mild = 2, moderate-severe = 3.
  • Encephalopathy: none = 1, grade 1-2 = 2, grade 3-4 = 3.
  • The five points are summed to a total of 5-15.

Interpreting the Result

  • Class A (5-6 points): well-compensated disease; ~100% 1-year and ~85% 2-year survival.
  • Class B (7-9 points): significant functional compromise; ~80% 1-year survival.
  • Class C (10-15 points): decompensated disease; ~45% 1-year survival.

Limitations & Pitfalls

  • Ascites and encephalopathy grading are subjective and observer-dependent.
  • Bilirubin cut-offs differ for cholestatic disease (e.g. primary biliary cholangitis).
  • Largely superseded by MELD for transplant allocation but still widely used for risk stratification.

References

  • Pugh RNH, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.
  • Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. Philadelphia: Saunders; 1964:50-64.

⚕️ For clinical decision support only. Always verify calculations and apply clinical judgment.