Child Pugh Score Calculator

Child-Pugh scores the functional severity of chronic liver disease across five domains, each graded 1 to 3 for a total of 5 to 15: bilirubin (synthetic / excretory function), albumin (long-term synthetic reserve), INR (acute synthetic function and clotting factor production), ascites (portal hypertension and renal handling of sodium), and hepatic encephalopathy (clearance of nitrogenous waste). Two of the five components, ascites and encephalopathy, are clinical judgments rather than lab values, which is what makes Child-Pugh quick at the bedside but also subjective. Total 5 to 6 is Class A (compensated), 7 to 9 is Class B (significant compromise), and 10 to 15 is Class C (decompensated).

The two-year survival figures most often cited in hepatology references trace back to the original 1973 Pugh et al. cohort of 38 cirrhotic patients undergoing esophageal transection for variceal bleeding: roughly 85 percent for Class A, 57 percent for Class B, and 35 percent for Class C. One-year survival in the same cohort was about 100 percent, 80 percent, and 45 percent. Modern cohorts on best medical therapy do better in Class A and B and somewhat better in Class C, but the rank order and the broad strokes hold. The numbers should be treated as a prognostic guide for shared decision making, not as a precise individual prediction.

MELD-Na is a continuous, lab-only score (bilirubin, creatinine, INR, sodium) derived from the original MELD regression model and is the score used by UNOS and most national registries to allocate deceased-donor livers since 2016. Because every input is objective, MELD-Na is reproducible across observers and well-calibrated for 90-day mortality on the transplant waitlist. Child-Pugh is a 5-to-15 categorical score that adds two clinical inputs (ascites and encephalopathy) that capture decompensation MELD does not see directly. In practice: MELD-Na drives transplant priority and 90-day mortality estimates, Child-Pugh stays useful for bedside severity grading, perioperative risk before non-transplant surgery, and quick classification of clinic patients.

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are cholestatic diseases in which bilirubin can rise substantially from impaired biliary excretion without the same prognostic weight that the same bilirubin would carry in a patient with hepatocellular cirrhosis. To avoid systematically overscoring PBC and PSC patients, the modified Child-Pugh uses widened bilirubin cut-offs: under 4 mg/dL scores 1 point, 4 to 10 mg/dL scores 2 points, and over 10 mg/dL scores 3 points. The other four components (albumin, INR, ascites, encephalopathy) are unchanged. Toggle the modified thresholds in the calculator when scoring a known PBC or PSC patient.

Mansour 1997 and later abdominal-surgery series in cirrhotic patients put perioperative mortality at roughly 10 percent for Class A, 30 percent for Class B, and over 80 percent for Class C. The implication is straightforward: Class A patients tolerate elective abdominal surgery reasonably well, Class B patients need careful preoperative optimization and a strong indication, and Class C patients should generally be deferred from anything other than life-saving surgery and routed through a transplant center. Emergency surgery in Class C is particularly dangerous because the underlying coagulopathy, portal hypertension, hypoalbuminemia, and renal vulnerability all compound under anesthesia. MELD-Na adds a quantitative perioperative risk estimator (Mayo Postoperative Mortality Risk Score) that should be paired with Child-Pugh when counseling cirrhotic patients about elective surgery.