Child-Pugh score calculator
Enter bilirubin, albumin and INR from a blood test and choose the degree of ascites and hepatic encephalopathy to get the Child-Pugh score and class used to describe how advanced cirrhosis is. It is an estimate for information, not a diagnosis.
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How to use it
- Pick the units on your lab report.
- Enter total bilirubin, albumin and INR.
- Choose the degree of ascites and of hepatic encephalopathy.
- Read the total score, the class and the points for each measure.
The point table
| Measure |
1 point |
2 points |
3 points |
| Bilirubin |
< 2 mg/dL (< 34 µmol/L) |
2–3 mg/dL (34–50 µmol/L) |
> 3 mg/dL (> 50 µmol/L) |
| Albumin |
> 3.5 g/dL (> 35 g/L) |
2.8–3.5 g/dL (28–35 g/L) |
< 2.8 g/dL (< 28 g/L) |
| INR |
< 1.7 |
1.7–2.3 |
> 2.3 |
| Ascites |
None |
Mild |
Moderate to severe |
| Encephalopathy |
None |
Grade 1–2 |
Grade 3–4 |
Total 5–6 is class A, 7–9 class B, 10–15 class C.
Worked example
Bilirubin 2.5 mg/dL (2 points), albumin 3.0 g/dL (2), INR 1.5 (1), mild ascites (2) and no encephalopathy (1): 2 + 2 + 1 + 2 + 1 = 8, class B.
Tips
- Ascites and encephalopathy are graded by the clinician; note how they were graded so that repeat scores are comparable.
- INR is affected by anticoagulants such as warfarin, which makes the score less meaningful.
- This is an estimate for information, not a diagnosis or a treatment decision.
Frequently asked questions
What do classes A, B and C mean?
Class A (5–6 points) is well-compensated liver disease, class B (7–9) significant functional impairment and class C (10–15) decompensated disease. The class helps doctors judge prognosis, the safety of surgery and drug doses.
Which thresholds does the calculator use?
Bilirubin below 2, 2–3 and above 3 mg/dL (below 34, 34–50 and above 50 µmol/L); albumin above 3.5, 2.8–3.5 and below 2.8 g/dL (above 35, 28–35 and below 28 g/L); INR below 1.7, 1.7–2.3 and above 2.3. Each band scores 1, 2 or 3 points.
Is there a different bilirubin scale for PBC or PSC?
Some sources use higher bilirubin cut-offs for primary biliary cholangitis and primary sclerosing cholangitis. This calculator uses the standard thresholds above.
How is Child-Pugh different from MELD?
Child-Pugh includes two clinical judgements (ascites and encephalopathy), while MELD uses only lab values: bilirubin, INR, creatinine and, in MELD-Na, sodium. MELD is used to rank patients for liver transplant.