Child-Pugh Score Calculator

inputs

Total bilirubin

Albumin

INR (or PT prolongation)

Ascites

Hepatic encephalopathy

✓ when to use

Use in patients with known or suspected cirrhosis to assess hepatic reserve, guide surgical risk assessment, inform prognosis discussions, and determine eligibility for procedures (e.g., TIPS, hepatic resection). Also used for drug dosing in hepatic impairment (many drug labels reference Child-Pugh class).

✗ when not to use

Child-Pugh has subjective components (ascites and encephalopathy grading) with inter-observer variability. MELD score is preferred for transplant prioritisation because it uses only objective laboratory variables. Not validated for acute liver failure (use KCH criteria). Not suitable for assessing disease progression in non-cirrhotic liver disease.

clinical pearls

Child-Pugh is better for day-to-day clinical assessment and drug dosing; MELD is better for transplant prioritisation and short-term mortality prediction. Know when to use which.
The two subjective variables (ascites and encephalopathy) are the main weakness. Two clinicians can grade the same patient differently, leading to class reassignment. Document your assessment clearly.
For drug dosing, most drug labels use 'mild' (Child-Pugh A), 'moderate' (B), and 'severe' (C) hepatic impairment. Check the drug's SmPC/label for specific dose adjustments per class.
A Child-Pugh score can fluctuate with acute decompensation events (variceal bleed, SBP, hepatorenal syndrome). Reassess after stabilisation for a more representative baseline score.
The score does not include renal function, which is a major prognostic factor in cirrhosis. This is why MELD (which includes creatinine) outperforms Child-Pugh for mortality prediction.

✓ when to use

✗ when not to use

clinical pearls

Child-Pugh is better for day-to-day clinical assessment and drug dosing; MELD is better for transplant prioritisation and short-term mortality prediction. Know when to use which.
The two subjective variables (ascites and encephalopathy) are the main weakness. Two clinicians can grade the same patient differently, leading to class reassignment. Document your assessment clearly.
For drug dosing, most drug labels use 'mild' (Child-Pugh A), 'moderate' (B), and 'severe' (C) hepatic impairment. Check the drug's SmPC/label for specific dose adjustments per class.
A Child-Pugh score can fluctuate with acute decompensation events (variceal bleed, SBP, hepatorenal syndrome). Reassess after stabilisation for a more representative baseline score.
The score does not include renal function, which is a major prognostic factor in cirrhosis. This is why MELD (which includes creatinine) outperforms Child-Pugh for mortality prediction.

Child-Pugh Score

inputs

✓ when to use

✗ when not to use

clinical pearls

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