Child Pugh Score

Evaluates severity of chronic liver cirrhosis based on five patient parameters.

In the text below the calculator there is more information on the items in the score and the result interpretation.

The Child Pugh score is a severity scoring system for patients suffering from liver disease, especially cirrhosis.

The scoring method also offers one year and two-year survival rates based on patient hepatic encephalopathy status, ascites assessment, INR, bilirubin and serum albumin values.

Each of the five clinical liver factors are awarded a number of points (from 1 to 3), depending on their severity.

The final score is then correlated with a class of disease severity and 1 and 2-year survival probability.

  Class A – Least severe liver disease Class B – Moderately severe liver disease Class C – Most severe derangement
Score 5, 6 points 7 – 9 points 10 – 15 points
1-year survival 100% 81% 45%
2-year survival 85% 57% 35%


Hepatic Encephalopathy


Ascites assessment


Bilirubin (mg/dL) clinical measure


Serum Albumin (g/dL) clinical measure


International normalized ratio (INR)

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The method explained

This is a disease severity evaluation based on the Child- Turcotte- Pugh score that determines the prognosis of hepatic disease.

There are two clinical assessments and three test measurements used to score cirrhosis and other liver disease:

■ The hepatic encephalopathy status varies from none to grade III or IV. This encephalopathy occurs when toxins from the blood affect the central nervous system because the liver is not able to eliminate them.

■ Ascites assessment refers to absence or presence of ascites, and if so, the level of severity. Liver dysfunction leads to fluid build up between the peritoneum layers.

■ Bilirubin level is an indicator of liver function, resulted from the metabolism of old red blood cells.

■ Serum albumin is normally between 2.8 and 3.5 g/dL and any disruption indicates impaired liver function.

■ International normalized ratio (INR) offers information on coagulation and reflects whether the liver produces clotting factors appropriately.


Score interpretation

The five items in the score are awarded points, from 1 to 3, depending on their weight on liver disease.

Factor 1 point 2 points 3 points
Hepatic encephalopathy None Grade I-II Grade III-IV
Ascites None Mild Moderate to Severe
Total bilirubin (mg/dL) <2 2 - 3 >3
Serum albumin (g/L) >35 28-35 <28
PT INR <1.7 1.71-2.30 >2.30

The final score is calculated by summing the points. This result is interpreted as belonging to one of three classes of disease severity, as described in the table below:

  Class A – Least severe liver disease Class B – Moderately severe liver disease Class C – Most severe derangement
Score 5, 6 points 7 – 9 points 10 – 15 points
1-year survival 100% 81% 45%
2-year survival 85% 57% 35%

Class A is also known as well compensated disease, class B shows significant functional compromise whilst class C indicates that hepatic disease is decompensated.


When to use the Child Pugh score

The original use of the Child- Turcotte- Pugh score was in surgery, as a mortality risk tool. Currently it has evolved to being used for prognostic purposes and to support other assessment methods in predicting the need for liver transplant (EPTS score).

The score is also often used in conjunction with the Model for End Stage Liver Disease, MELD score, especially in patient with abnormally high or low scores.

The score can evaluate disease severity in the following conditions:

■ Ascites;

■ Alcoholic or billiary cirrhosis;

■ Cirrhosis from Hepatitis C virus;

■ Primary sclerosing cholangitis;

■ Ruptured esophageal varices.


Original source

Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.


Pugh RNH, Murray-Lyon IM, Dawson JL et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:649-9.

Other references

1. Hyung JK, Hyun WL. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol. 2013; 19(2): 105–115.

2. Peng Y, Qi X, Guo X. Child–Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis - A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 2016; 95(8): e2877.

Specialty: Hepatology

System: Digestive

Objective: Evaluation

Type: Score

No. Of Items: 5

Year Of Study: 1964

Article By: Denise Nedea

Published On: May 30, 2017

Last Checked: May 30, 2017

Next Review: May 30, 2023