The liver plays a vital role in detoxification, metabolism, and overall health. When the liver is severely damaged due to conditions such as cirrhosis or chronic hepatitis, doctors need reliable ways to measure the severity of the disease. One of the most widely used tools for this purpose is the Child-Pugh Score, which classifies the prognosis of liver disease patients.
Child-Pugh Score Calculator
How to Use the Child-Pugh Calculator
This calculator requires five clinical inputs:
- Bilirubin level (mg/dL or µmol/L)
- Albumin level (g/dL or g/L)
- Prothrombin time or INR
- Ascites severity (none, mild, moderate to severe)
- Hepatic encephalopathy severity (none, grade 1–2, grade 3–4)
Steps:
- Enter the patient’s bilirubin, albumin, and INR/prothrombin time.
- Select ascites and encephalopathy levels based on clinical evaluation.
- The calculator assigns points for each input (1, 2, or 3).
- The total score determines the Child-Pugh class:
- Class A (5–6 points): Well-compensated disease
- Class B (7–9 points): Significant functional compromise
- Class C (10–15 points): Decompensated disease
Child-Pugh Score Formula
Each variable is scored 1–3 points based on severity:
- Bilirubin
- <2 mg/dL = 1 point
- 2–3 mg/dL = 2 points
- 3 mg/dL = 3 points
- Albumin
- 3.5 g/dL = 1 point
- 2.8–3.5 g/dL = 2 points
- <2.8 g/dL = 3 points
- Prothrombin Time (Seconds over control) or INR
- PT <4 sec or INR <1.7 = 1 point
- PT 4–6 sec or INR 1.7–2.3 = 2 points
- PT >6 sec or INR >2.3 = 3 points
- Ascites
- None = 1 point
- Mild = 2 points
- Moderate/Severe = 3 points
- Hepatic Encephalopathy
- None = 1 point
- Grade 1–2 = 2 points
- Grade 3–4 = 3 points
Final Score = Sum of all five components
Example Calculation
A patient presents with:
- Bilirubin: 3.2 mg/dL → 3 points
- Albumin: 3.0 g/dL → 2 points
- INR: 2.0 → 2 points
- Ascites: Mild → 2 points
- Encephalopathy: Grade 1 → 2 points
Total Score = 3 + 2 + 2 + 2 + 2 = 11 points
Classification: Child-Pugh Class C (decompensated liver disease).
Clinical Significance of the Child-Pugh Score
- Class A (5–6 points) → Good prognosis, 1-year survival >95%
- Class B (7–9 points) → Moderate prognosis, 1-year survival ~80%
- Class C (10–15 points) → Poor prognosis, 1-year survival ~45%
Doctors use this score to:
- Assess disease progression
- Evaluate surgical risk (e.g., liver resection, shunt surgery)
- Decide eligibility for liver transplantation
- Monitor treatment outcomes
Helpful Information
- The Child-Pugh score is not diagnostic; it’s a prognostic tool.
- For more precise prognosis, it is often combined with the MELD score.
- The calculator is widely used in hepatology, gastroenterology, and transplant surgery.
- Regular monitoring of inputs (bilirubin, albumin, INR, etc.) ensures accuracy.
- Patients with Class B or C usually require closer follow-up and advanced treatment.
20 Frequently Asked Questions (FAQs)
1. What is the Child-Pugh Calculator used for?
It measures the severity of chronic liver disease and predicts prognosis.
2. Who developed the Child-Pugh Score?
It was first introduced by Child and Turcotte, later modified by Pugh in 1973.
3. What are the five components of the score?
Bilirubin, albumin, prothrombin time/INR, ascites, and encephalopathy.
4. What does Class A mean in Child-Pugh?
It indicates well-compensated liver disease with good survival.
5. What does Class B indicate?
Moderately impaired liver function and higher risk of complications.
6. What does Class C mean?
Severe liver disease with poor prognosis and need for transplant evaluation.
7. How accurate is the Child-Pugh score?
It provides a reliable estimate of disease severity but is not absolute.
8. Can it predict survival?
Yes, survival rates decrease with higher classes.
9. How is Child-Pugh different from MELD score?
MELD uses lab values only; Child-Pugh also includes clinical factors.
10. Why is albumin important?
It reflects liver’s ability to synthesize proteins.
11. What role does bilirubin play?
It measures liver’s ability to excrete bile.
12. Why is INR used?
It indicates clotting ability, which depends on liver function.
13. How is ascites scored?
By severity: none, mild, or moderate/severe.
14. How is encephalopathy assessed?
By mental status changes (none, mild, severe).
15. Can the score change over time?
Yes, as liver disease progresses or improves with treatment.
16. Who should use this calculator?
Doctors, medical students, and patients under physician supervision.
17. Is it useful in acute liver failure?
No, it’s mainly for chronic liver disease.
18. Can patients use it at home?
They can, but results must be interpreted by a doctor.
19. Is it used before surgery?
Yes, it helps assess surgical risk in liver disease patients.
20. Does a high score mean transplant is required?
Often yes, especially for Class C patients.
Final Thoughts
The Child-Pugh Calculator is an essential tool in assessing liver disease severity. By evaluating five critical parameters—bilirubin, albumin, INR, ascites, and encephalopathy—it provides a quick yet reliable estimate of prognosis.