Instructions
Select the appropriate value for each parameter based on the patient's current clinical and laboratory findings. The Child-Pugh score helps assess the severity of liver disease and predict survival in patients with cirrhosis.
Total Bilirubin
Unit: mg/dL
Serum Albumin
Unit: g/dL
INR (International Normalized Ratio)
Ascites
Hepatic Encephalopathy
Child-Pugh Score Interpretation
5-6 points (Class A): Well-compensated cirrhosis
7-9 points (Class B): Moderately decompensated cirrhosis
10-15 points (Class C): Severely decompensated cirrhosis
Clinical Management
- Class A (5-6): Consider elective procedures, monitor for decompensation
- Class B (7-9): Optimize medical therapy, consider transplant evaluation
- Class C (10-15): Urgent transplant evaluation, manage complications
- ⚠️ Monitor for complications: variceal bleeding, ascites, encephalopathy
About Child-Pugh Score
- Validated scoring system for cirrhosis severity
- Assesses 5 parameters: bilirubin, albumin, INR, ascites, encephalopathy
- Each parameter scored 1-3 points
- Total score range: 5-15 points
- Predicts survival and guides treatment decisions
- Used for transplant allocation and risk stratification
Child-Pugh Score Calculator
The Child-Pugh score is a validated scoring system used to assess the severity of liver disease and predict survival in patients with cirrhosis. It evaluates five clinical and laboratory parameters to classify patients into three categories that correlate with prognosis and survival.
Child-Pugh Parameters
The Child-Pugh score assesses the following five parameters:
- Total Bilirubin: Reflects liver synthetic function and cholestasis
- Serum Albumin: Indicates liver synthetic function and nutritional status
- INR (International Normalized Ratio): Measures coagulation function
- Ascites: Clinical manifestation of portal hypertension
- Hepatic Encephalopathy: Neurological complication of liver failure
Scoring System
Each parameter is scored from 1 to 3 points based on severity:
Total Bilirubin (mg/dL)
- 1 point: < 2.0
- 2 points: 2.0 - 3.0
- 3 points: > 3.0
Serum Albumin (g/dL)
- 1 point: > 3.5
- 2 points: 2.8 - 3.5
- 3 points: < 2.8
INR (International Normalized Ratio)
- 1 point: < 1.7
- 2 points: 1.7 - 2.3
- 3 points: > 2.3
Ascites
- 1 point: None
- 2 points: Mild
- 3 points: Moderate to severe
Hepatic Encephalopathy
- 1 point: None
- 2 points: Grade 1-2
- 3 points: Grade 3-4
Total score range: 5-15 points
Score Interpretation
Child-Pugh Class A (5-6 points)
- Clinical significance: Well-compensated cirrhosis
- 1-year survival: 100%
- 2-year survival: 85%
- Management: Consider elective procedures, monitor for decompensation
- Transplant priority: Low
- Risk of complications: Low
Child-Pugh Class B (7-9 points)
- Clinical significance: Moderately decompensated cirrhosis
- 1-year survival: 80%
- 2-year survival: 60%
- Management: Optimize medical therapy, consider transplant evaluation
- Transplant priority: Medium
- Risk of complications: Moderate
Child-Pugh Class C (10-15 points)
- Clinical significance: Severely decompensated cirrhosis
- 1-year survival: 45%
- 2-year survival: 35%
- Management: Urgent transplant evaluation, manage complications
- Transplant priority: High
- Risk of complications: High
Clinical Applications
Prognostic Assessment
- Survival prediction: Correlates with 1-year and 2-year survival
- Risk stratification: Helps identify high-risk patients
- Treatment planning: Guides intensity of monitoring and intervention
- Resource allocation: Assists in healthcare resource planning
Transplant Evaluation
- Listing criteria: Used in transplant allocation systems
- Priority determination: Helps prioritize transplant candidates
- Risk assessment: Evaluates perioperative risk
- Outcome prediction: Predicts post-transplant outcomes
Surgical Risk Assessment
- Elective surgery: Class A patients generally safe for elective procedures
- Emergency surgery: Higher risk in Class B and C patients
- Perioperative management: Guides perioperative care
- Complication risk: Predicts postoperative complications
Important Considerations
Limitations
- Subjective assessment of ascites and encephalopathy
- May not capture rapid clinical changes
- Limited sensitivity for early cirrhosis
- Does not account for etiology of liver disease
- May not reflect current liver function accurately
- Limited utility in acute liver failure
Comparison with MELD Score
- Child-Pugh: Includes subjective parameters, better for long-term prognosis
- MELD: Uses only objective laboratory values, better for short-term survival
- Clinical use: MELD preferred for transplant allocation, Child-Pugh for general prognosis
- Validation: Both validated in multiple populations
Special Populations
- Cholestatic liver disease: Bilirubin may be elevated without severe disease
- Malnutrition: Albumin may be low due to nutritional factors
- Anticoagulation: INR may be elevated due to medications
- Renal dysfunction: May affect interpretation of parameters
Clinical Pearls
- Use clinical judgment in addition to the Child-Pugh score
- Monitor for changes in score over time
- Consider etiology of liver disease in interpretation
- Assess for complications regardless of score
- Use in conjunction with other prognostic tools
- Consider patient preferences and quality of life
- Document score changes in medical records
- Reassess if patient condition changes significantly
Management Recommendations
Class A Patients
- Routine monitoring every 3-6 months
- Screen for hepatocellular carcinoma
- Monitor for varices if not already done
- Optimize treatment of underlying liver disease
- Consider elective procedures if needed
Class B Patients
- More frequent monitoring (every 1-3 months)
- Aggressive management of complications
- Consider transplant evaluation
- Optimize medical therapy
- Monitor for decompensation
Class C Patients
- Frequent monitoring (every 1-4 weeks)
- Urgent transplant evaluation
- Aggressive management of complications
- Consider palliative care options
- Monitor for acute decompensation
Complications to Monitor
Portal Hypertension Complications
- Variceal bleeding: Screen and prophylax appropriately
- Ascites: Manage with diuretics and sodium restriction
- Spontaneous bacterial peritonitis: Monitor for signs of infection
- Hepatorenal syndrome: Monitor renal function closely
Hepatic Encephalopathy
- Monitor mental status regularly
- Treat precipitating factors
- Consider lactulose and rifaximin
- Assess driving safety
Hepatocellular Carcinoma
- Regular surveillance with imaging
- Monitor alpha-fetoprotein levels
- Consider screening every 6 months
- Early detection improves outcomes
This calculator provides a validated method for assessing cirrhosis severity and predicting survival, helping to guide treatment decisions and transplant evaluation. The Child-Pugh score is widely used in hepatology practice and has been validated in multiple populations and settings.
References
- Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.
- Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85.
- Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
- Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42 Suppl(1):S100-S107.
- Malinchoc M, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864-871.
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