Child-Pugh Score Calculator
Child-Pugh points and class from bilirubin, albumin, INR, ascites, and encephalopathy.
What it does
The Child-Pugh score turns five bedside and lab findings into one of three classes that describe how far cirrhosis has progressed. It has been in use since the 1960s and still shapes prognosis discussions, surgical risk estimates, and treatment limits.
Two of the five measures come from a physical exam: ascites, which is fluid in the abdomen, and encephalopathy, the confusion and drowsiness that liver failure brings. The other three come from labs: total bilirubin, serum albumin, and the INR. Each measure scores 1, 2, or 3 points, so the total spans 5 to 15.
The class tells a practical story. Class A means well compensated disease, with a median survival measured in years. Class B means moderate liver dysfunction, and clinicians often break it into B7, B8, and B9 for finer comparisons. Class C means severe decompensation, where survival drops sharply and certain treatments carry heavy risk.
The tool applies the point bands from the original classification. Bilirubin scores 1 point under 2 mg/dL, 2 points from 2 to 3, and 3 points above 3. Albumin scores 1 point above 3.5 g/dL, 2 points from 2.8 to 3.5, and 3 points below 2.8. The INR scores 1 point below 1.7, 2 points from 1.7 to 2.3, and 3 points above 2.3.
The ascites and encephalopathy scales track clinical severity: none scores 1, mild or controlled disease scores 2, and marked or refractory disease scores 3. Because two of the five inputs are judgment calls, two observers can land on different totals. The score supports a specialist's assessment of cirrhosis rather than standing alone.
How to use
- Enter the total bilirubin in mg/dL.
- Enter the serum albumin in g/dL.
- Enter the INR.
- Set ascites to none, mild to moderate, or severe.
- Set encephalopathy to none, grade 1 to 2, or grade 3 to 4.
- Read the total, its class, and the point breakdown for each measure.
Formula
- bilirubin
- Total bilirubin in mg/dL; under 2 scores 1, over 3 scores 3.
- albumin
- Serum albumin in g/dL; above 3.5 scores 1, below 2.8 scores 3.
- INR
- Prothrombin time ratio; under 1.7 scores 1, over 2.3 scores 3.
- ascites / enceph
- Clinical severity scales: none 1, controlled 2, marked 3.
The original classification used prothrombin time prolonged seconds and two different encephalopathy grade groupings; the modified version with INR is the standard in current practice. Class cutoffs: 5 to 6 is A, 7 to 9 is B, 10 to 15 is C.
Worked example
Example: bilirubin 2.2, albumin 3.1, INR 1.6, mild ascites, no encephalopathy
Total bilirubin 2.2 mg/dL, albumin 3.1 g/dL, INR 1.6, mild to moderate ascites, no encephalopathy.
- Bilirubin 2.2 sits between 2 and 3: 2 points.
- Albumin 3.1 sits between 2.8 and 3.5: 2 points.
- INR 1.6 is under 1.7: 1 point.
- Mild to moderate ascites: 2 points.
- No encephalopathy: 1 point.
- The total is 2 + 2 + 1 + 2 + 1 = 8, which is Class B.
Reference table
| Measure | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin | Under 2 mg/dL | 2 to 3 mg/dL | Over 3 mg/dL |
| Serum albumin | Over 3.5 g/dL | 2.8 to 3.5 g/dL | Under 2.8 g/dL |
| INR | Under 1.7 | 1.7 to 2.3 | Over 2.3 |
| Ascites | None | Mild to moderate | Severe |
| Encephalopathy | None | Grade 1 to 2 | Grade 3 to 4 |
Limits
- Two of the five measures are clinical judgment, so totals can vary between observers.
- Does not include newer markers such as sodium, creatinine, or MELD inputs.
- Class assignments come from group survival data, not individual predictions.
- The INR based version differs slightly from the original prothrombin time version.
Common mistakes
- Entering bilirubin in micromoles per litre; the formula expects mg/dL.
- Scoring ascites that is controlled by diuretics as severe when it is mild to moderate.
- Treating Class B as a single group instead of reading the exact score within B7 to B9.
- Forgetting that Class A already means cirrhosis is not fully compensated.
- Reading the class as a transplant listing rule; allocation runs on MELD and related scores.
Try it yourself
Quick checks. Answers sit tucked under each question.
Bilirubin 1.2 mg/dL, albumin 3.8 g/dL, INR 1.2, no ascites, no encephalopathy?
Score 5, Class A: every measure scores 1 point.
Bilirubin 3.4 mg/dL, albumin 2.5 g/dL, INR 2.6, severe ascites, grade 3 to 4 encephalopathy?
Score 15, Class C: every measure scores 3 points.
Bilirubin 2.0 mg/dL, albumin 2.8 g/dL, INR 1.7 on the nose, no ascites or encephalopathy?
Score 8, Class B: the boundary values score 2 points each.
Questions
What do the classes mean?
Class A (5 to 6) is well compensated, Class B (7 to 9) is moderate dysfunction with subclasses B7 to B9, and Class C (10 to 15) is severe decompensation.
Why does the score start at 5?
Each of the five measures scores at least 1 point, so 5 is the minimum and 15 is the maximum.
Is Child-Pugh still used?
Yes. It guides prognosis, surgical risk, and some treatment limits, while MELD drives transplant allocation.
Which version uses INR?
The modified classification replaced prothrombin time with INR, and that is the version this page implements.
Can I use this for a child?
Children with biliary atresia and related conditions use the Pediatric End-Stage Liver Disease score instead.
How often should it be repeated?
As often as the clinical picture changes; the inputs shift with flares, treatment, and disease progression.
Sources
- NCBI: Child-Pugh classification, scoring table and classes
- NCBI: modified Child-Pugh cut points with INR