Calculators & Tools

Child-Pugh Score

Severity of chronic liver disease and prognosis in cirrhosis

1 What is the Child-Pugh Score?

The Child-Pugh score grades the severity of chronic liver disease from five variables and sorts patients into class A, B or C. It remains widely used for prognosis in cirrhosis and for judging the risk of surgery and of certain drugs in hepatic impairment.

2 When to use it

  • Grading severity in a child or adolescent with established cirrhosis
  • Assessing peri-operative risk in chronic liver disease
  • Deciding dose adjustment for drugs cleared by the liver
  • Serial assessment of a patient with progressive liver disease

3 Formula & method

Five variables are each scored 1 to 3: total bilirubin, serum albumin, INR, ascites and hepatic encephalopathy. The total sorts into class A, class B or class C, with rising class indicating worse hepatic reserve and prognosis. Ascites and encephalopathy are graded clinically, which introduces some inter-observer variation.
  • Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973

4 Frequently asked questions

What do the classes mean?

Class A indicates well-compensated disease, class B significant functional compromise and class C decompensated disease. The app names the class from the total.

Is Child-Pugh or MELD better?

They answer different questions. MELD and PELD are used for transplant prioritisation and are purely laboratory-based; Child-Pugh includes clinical variables and remains common for surgical risk and drug dosing.

Can it be used in children?

It is used in paediatric hepatology, though PELD is the standard for transplant allocation in children under 12.

Why do two clinicians get different scores?

Ascites and encephalopathy are clinical gradings rather than measurements, so they can be scored differently by different assessors.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.