Child Pugh Calculator — Cirrhosis Severity

Use the Child‑Pugh Calculator

Enter albumin, bilirubin, INR, and select ascites/encephalopathy to see the total score and Child‑Pugh class (A, B, or C).

How to Use Child Pugh Calculator — Cirrhosis Severity

1. Step 1: Choose Units

   Pick units for bilirubin (mg/dL or µmol/L) and albumin (g/dL or g/L) so they match your lab report.

2. Step 2: Enter Labs

   Type your total bilirubin, serum albumin, and INR. Inputs accept decimals and are optimized for mobile.

3. Step 3: Select Findings

   Choose ascites severity (none, mild/moderate, severe) and encephalopathy grade (none, I–II, III–IV).

4. Step 4: Calculate Score

   Tap Calculate to see the per‑criterion points, total Child‑Pugh score, and Class A/B/C badge.

5. Step 5: Review Guidance

   Compare your class with the brief notes and consider related tools like MELD for short‑term risk.

Key Features

• Child‑Pugh class (A/B/C) with total score
• Per‑criterion points breakdown for transparency
• Unit toggles for bilirubin (mg/dL/µmol/L) and albumin (g/dL/g/L)
• Mobile‑first design with quick reset and guidance

Understanding Results

Formula

Child‑Pugh assigns 1–3 points to five items: total bilirubin (<2, 2–3, >3 mg/dL), serum albumin (>3.5, 2.8–3.5, <2.8 g/dL), INR (<1.7, 1.7–2.3, >2.3), ascites (none, mild/moderate, severe), and hepatic encephalopathy (none, Grade I–II, Grade III–IV). The sum (5–15) maps to Class A (5–6), B (7–9), or C (10–15).

Reference Ranges & Interpretation

Class A often reflects compensated disease; Class B indicates significant functional compromise; Class C signals decompensation with higher risk of complications. Use the score to describe severity, not to predict an individual outcome. For transplant allocation and short‑term mortality, also consider MELD/MELD‑Na.

Assumptions & Limitations

Albumin can be low for non‑hepatic reasons, INR can be medication‑affected, and ascites/encephalopathy grading is semi‑subjective. Always interpret results in context. For clinical background, see NCBI StatPearls.

Complete Guide: Child Pugh Calculator — Cirrhosis Severity

Use our child pugh calculator to grade cirrhosis severity (Class A, B, or C) from albumin, bilirubin, INR, ascites, and encephalopathy. Fast, mobile results.

If you need a concise bedside tool, our child pugh calculator translates five inputs into a single severity grade for cirrhosis. It is designed for speed on mobile and clarity at a glance, so you can enter albumin, bilirubin, INR, and clinical findings (ascites and encephalopathy) and immediately see the score and class.

Interpreting results in the Child‑Pugh calculator

Use the class primarily as a severity snapshot, not a prediction for an individual. Class A often reflects compensated disease; Class B and C suggest rising risk and a need for closer follow‑up. If results are near a boundary, re‑check inputs and clinical findings, then discuss the trend with your clinician.

What the Child‑Pugh score measures

The Child‑Turcotte‑Pugh (CTP, commonly shortened to Child‑Pugh) score summarizes the severity of chronic liver disease, particularly cirrhosis. It blends three laboratory markers of synthetic and excretory function (albumin, bilirubin, and INR) with two bedside clinical findings (ascites and hepatic encephalopathy). The total ranges from 5 to 15 points and assigns patients into Class A (5–6), B (7–9), or C (10–15). The higher the class, the greater the functional impairment and risk of complications.

Because Child‑Pugh is simple and widely taught, teams across surgery, anesthesia, hepatology, and primary care can communicate quickly using the same shorthand. Surgeons, for example, often avoid elective major abdominal operations in advanced Class C without optimization; in contrast, many Class A patients can undergo procedures after careful risk assessment. In clinics, the class also shapes follow‑up cadence and the urgency of discussions about transplant referral or palliative care supports.

This staging has persisted because it is intuitive and practical. Even though modern transplant allocation uses MELD, clinicians still reference Child‑Pugh to describe overall condition, to judge operative risk, or to guide surveillance and counseling. You can explore MELD with our MELD score calculator for a complementary lens on short‑term mortality risk.

How the score is calculated

Each of the five criteria is assigned 1, 2, or 3 points. Laboratory values use fixed thresholds, while clinical findings use graded severity. The points are summed to a total, which maps to Class A, B, or C. Our implementation mirrors the widely used cutoffs and shows a clear per‑criterion breakdown so you always see how the total emerged.

• Total bilirubin (mg/dL): <2 = 1 point, 2–3 = 2 points, >3 = 3 points.
• Serum albumin (g/dL): >3.5 = 1 point, 2.8–3.5 = 2 points, <2.8 = 3 points.
• INR: <1.7 = 1 point, 1.7–2.3 = 2 points, >2.3 = 3 points.
• Ascites: none = 1 point, mild/moderate (diuretic‑responsive) = 2 points, severe (refractory) = 3 points.
• Hepatic encephalopathy: none = 1 point, Grade I–II = 2 points, Grade III–IV = 3 points.

Because labs may be reported in different units, the tool supports bilirubin in mg/dL or µmol/L and albumin in g/dL or g/L. It converts under the hood and displays a normalized summary so you can check the thresholds against the same scale used by Child‑Pugh.

If you are documenting care, consider recording both the raw lab values with their units and the resulting points, e.g., “bilirubin 2.6 mg/dL → 2 points; albumin 3.1 g/dL → 2 points; INR 1.9 → 2 points; ascites mild/moderate → 2 points; encephalopathy none → 1 point; total 9 → Class B.” Clear notes help future readers audit the calculation and see trends across time.

Criteria explained (with ranges)

Bilirubin reflects the liver’s excretory function. When hepatocytes or bile ducts are impaired, bilirubin accumulates and jaundice may develop. The Child‑Pugh thresholds are broad on purpose: they indicate meaningful shifts in clearance rather than tiny lab fluctuations.

Albumin is synthesized by the liver. Lower values point to reduced synthetic capacity and can contribute to edema and ascites via decreased oncotic pressure. Hypoalbuminemia, however, can be multifactorial—malnutrition, renal losses, and inflammation can all push it down—so results should be interpreted in context.

INR captures clotting factor synthesis. As cirrhosis advances, the balance of pro‑ and anti‑coagulant factors changes; INR tends to rise. Be mindful that warfarin and certain antibiotics can elevate INR independent of liver function.

Ascites indicates portal hypertension and sodium/water dysregulation. “Mild/moderate” generally means controlled with diuretics and outpatient care; “severe” suggests refractory ascites with frequent taps or hospitalization. Our calculator lets you pick what matches the clinical reality rather than forcing a number.

Hepatic encephalopathy ranges from subtle sleep‑wake reversal or impaired concentration (Grade I–II) to somnolence, confusion, and coma (Grade III–IV). Precipitating factors include constipation, GI bleeding, infection, and sedatives. The score emphasizes the highest grade observed around the time of assessment.

Where possible, standardize how you assess these findings. For ascites, align with physical exam, ultrasound impressions, and diuretic response. For encephalopathy, use West Haven descriptors and ask caregivers about baseline versus current cognition. Consistency reduces variability and makes the Child‑Pugh class more reliable from visit to visit.

Interpreting Classes A–C

The total assigns one of three classes: Class A (5–6) usually denotes well‑compensated disease; Class B (7–9) indicates significant functional impairment; and Class C (10–15) represents decompensation with higher risk of complications such as variceal bleeding, refractory ascites, and recurrent encephalopathy. Historical estimates suggest roughly higher one‑year survival in Class A and substantially lower in Class C, but exact outcomes vary by etiology, age, comorbidities, and care environment. Use the score to describe severity, not to make individual predictions.

When communicating results, keep language simple: “Class A suggests milder disease,” “Class B means the liver is under more strain,” and “Class C signals advanced disease with greater risk.” Our tool shows the class badge with a brief note to help contextualize the number during care planning.

Several practical thresholds align with the classes. For example, many elective procedures are best deferred or carefully weighed in Class C given bleeding risks and decompensation. Nutrition counseling, vaccination, alcohol cessation, and variceal surveillance are priorities across all classes, but escalation to transplant teams often follows recurrent decompensations or rising MELD.

Child‑Pugh vs. MELD

MELD (Model for End‑Stage Liver Disease) relies entirely on lab values (bilirubin, creatinine, and INR; with updates adding sodium) and is used for transplant allocation because it better captures short‑term mortality. Child‑Pugh, by contrast, blends objective labs with two clinical findings, producing a more holistic bedside snapshot. Neither replaces clinical judgment. If you are evaluating complications or considering escalation of care, it is reasonable to calculate both: try the MELD score calculator alongside this page.

For broader liver assessment beyond staging, you may also find these helpful: liver function calculator, AST/ALT ratio calculator, and creatinine clearance calculator. For risk counseling tied to overall health, the adult BMI calculator can help frame weight‑related targets that influence ascites and fatty liver management.

Think of Child‑Pugh as a holistic snapshot and MELD‑Na as a lab‑driven risk meter. They answer different but complementary questions. If the Child‑Pugh class worsens while MELD‑Na remains stable, ask what clinical factors (encephalopathy, ascites) are driving decline and whether targeted interventions can reverse them.

Worked examples

Example 1: compensated cirrhosis (likely Class A). A 52‑year‑old with known hepatitis C–related cirrhosis has albumin 3.7 g/dL (1 point), bilirubin 1.5 mg/dL (1 point), INR 1.3 (1 point), no ascites (1 point), and no encephalopathy (1 point). Total = 5 points → Class A. Counseling emphasizes vaccination, surveillance for varices and hepatocellular carcinoma, and nutrition.

Example 2: diuretic‑responsive ascites (Class B). A 64‑year‑old with alcoholic cirrhosis shows albumin 3.1 g/dL (2 points), bilirubin 2.6 mg/dL (2 points), INR 1.9 (2 points), mild ascites (2 points), no encephalopathy (1 point). Total = 9 points → Class B. Discuss sodium restriction, titration of diuretics, and close follow‑up; consider transplant referral depending on MELD and overall course.

Example 3: refractory ascites and encephalopathy (Class C). A 70‑year‑old with NASH cirrhosis reports albumin 2.5 g/dL (3 points), bilirubin 3.4 mg/dL (3 points), INR 2.5 (3 points), severe ascites (3 points), Grade II encephalopathy (2 points). Total = 14 points → Class C. Management centers on complications, safety at home, caregiver support, and discussions about transplant eligibility or palliative goals of care.

Borderline case: class transition. A patient oscillates between albumin 3.4 and 3.6 g/dL and between mild ascites and none. On one visit the total is 6 (Class A), on another 7 (Class B). Rather than fixate on the single letter, document drivers of change and whether they are reversible—sodium intake, diuretic adherence, infection, GI bleeding, or medication effects. The goal is sustained improvement, not chasing a threshold.

Limitations and caveats

Like any summary score, Child‑Pugh trades nuance for simplicity. Bilirubin can be elevated for non‑hepatic reasons (e.g., hemolysis). Albumin can be low from malnutrition, renal or GI losses, or inflammation. INR can be affected by medications. Ascites and encephalopathy assessment is semi‑subjective and can vary between observers. Cholestatic diseases (like primary biliary cholangitis) often show disproportionate bilirubin elevations relative to synthetic function, which can inflate the score.

Use a consistent method, compare to prior baselines, and interpret alongside a full history, exam, and imaging. For decision points that hinge on short‑term mortality (e.g., TIPS candidacy, transplant listing), MELD‑Na generally offers stronger discrimination. For lifestyle and dietary guidance that may ease ascites and metabolic drivers, start with practical targets; our calculators index and Health Monitoring & Labs pages collect related tools in one place.

Finally, remember that the score is a moment in time. Acute illnesses (e.g., spontaneous bacterial peritonitis, pneumonia) can transiently worsen labs and cognition; improvements after treatment may change class. When in doubt, reassess and consider helpful adjuncts such as ultrasound for ascites estimation, medication reconciliation for encephalopathy triggers, and nutrition consults for sarcopenia.

Managing cirrhosis: practical steps

Management depends on the cause and complications, but several themes recur: limit alcohol, vaccinate appropriately, maintain adequate protein intake, and avoid unnecessary hepatotoxins. Sodium restriction helps control ascites; diuretics are titrated carefully; encephalopathy is managed with bowel regimen and trigger avoidance; and bleeding risks are reduced with endoscopic and pharmacologic strategies where indicated. Nutritional support is crucial, especially in sarcopenia.

Child‑Pugh can guide the tone of counseling. Class A patients often focus on surveillance and long‑term prevention; Class B work on aggressive complication control and timely referrals; Class C prioritize safety, support systems, and goals‑of‑care conversations. Across all classes, vaccination (hepatitis A/B, pneumococcal, influenza), medication review, and lifestyle supports remain foundational.

Track changes consistently. Repeat labs with the same units when possible, and note clinical shifts in ascites or cognition. If the score changes, consider whether that reflects progression, a precipitating event, or a reversible factor. Complement the score with targeted tools when questions arise—MELD for allocation and short‑term risk, and focused calculators like liver function or AST/ALT ratio when interpreting abnormal enzymes.

Day‑to‑day, small habits matter: protein at each meal (unless otherwise directed), a routine sleep schedule to stabilize encephalopathy risk, and early attention to constipation, infection signs, or GI bleeding. Encourage patients and families to keep a simple log—weight, abdominal girth, bowel movements, medications—that they can review at visits to spot trends early.

Further reading & sources

To keep this guide useful and grounded, we favor practical clinical references:

• Child‑Turcotte‑Pugh Classification — StatPearls, NCBI Bookshelf (NIH)
• American Association for the Study of Liver Diseases (AASLD) practice resources

This content is informational and not a diagnosis. Always work with your clinician for decisions about testing, procedures, and medications.

Frequently Asked Questions