Child-Pugh score calculator

Scores liver function from bilirubin, albumin, INR (or prothrombin time), ascites and hepatic encephalopathy and gives Child-Pugh class A, B or C.

For healthcare professionals. Runs on your device. Nothing you enter is saved or sent.

Child-Pugh score

When this estimate is not valid

Ascites and encephalopathy grades are clinical judgements; observers can score them differently.
Pugh's original table used prothrombin time in seconds above control; the INR bands are a later adaptation. Anticoagulants such as warfarin raise the INR without liver disease.
Drug labels use Child-Pugh classes as defined in their own studies; read the label's hepatic impairment section.
Bilirubin and albumin also change for reasons other than liver disease (for example haemolysis, Gilbert syndrome, nephrotic syndrome).

Estimate only. Interpret it with the patient's clinical picture and the product label.

How it is calculated

Each of the five items scores 1, 2 or 3 points. Bilirubin: below 2, 2–3, above 3 mg/dL. Albumin: above 3.5, 2.8–3.5, below 2.8 g/dL. INR: below 1.7, 1.7–2.3, above 2.3; or prothrombin time above control: below 4, 4–6, above 6 seconds. Ascites: none, slight, moderate to severe. Hepatic encephalopathy: none, grade 1–2, grade 3–4.

A value exactly on a shared boundary (bilirubin 2 or 3 mg/dL, albumin 2.8 or 3.5 g/dL, INR 1.7 or 2.3, prothrombin time 4 or 6 seconds) scores the middle band, 2 points. Published tables list these boundaries in two bands without saying which one owns them.

For primary biliary cholangitis (PBC) Pugh used bilirubin bands of 1–4, 4–10 and over 10 mg/dL; they are also commonly applied to primary sclerosing cholangitis (PSC). Choose the PBC or PSC option to use them.

The total gives the class: A 5–6 points, B 7–9 points, C 10–15 points.

SI units: bilirubin in µmol/L is divided by 17.1 and albumin in g/L by 10 before the bands are applied (34.2 µmol/L = 2.0 mg/dL). Some SI tables use rounded cut-offs (below 34, 34–50, above 50 µmol/L), so a bilirubin between 50 and 51.3 µmol/L scores 2 points here and 3 on those tables.

Worked example

Bilirubin 2.5 mg/dL (2 points), albumin 3.0 g/dL (2), INR 1.8 (2), slight ascites (2), no encephalopathy (1):

2 + 2 + 2 + 2 + 1 = 9 → B

9 points: Child-Pugh class B.

Questions

Should I use INR or prothrombin time?

Pugh's 1973 table used prothrombin time in seconds above control. Most current tables use INR bands (below 1.7, 1.7–2.3, above 2.3), a later adaptation. Choose the test you have. Anticoagulants such as warfarin raise the INR without liver disease.

How do drug labels use the Child-Pugh class?

Many labels give hepatic impairment dosing by Child-Pugh class A, B or C, as defined in the label's own studies. Read the hepatic impairment section of the label; the calculator gives the class only.

Why does a value on a boundary score 2 points?

Published tables give ranges that share their end points (for example bilirubin "2–3" and "above 3") without saying which band owns the end point. This calculator scores the end points in the middle band, as stated in its method.

Where does the score come from?

Pugh and colleagues published it in 1973 for patients having surgery for bleeding oesophageal varices, as a modification of the earlier Child-Turcotte classification. It is now widely used to grade chronic liver disease.

References

Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. DOI 10.1002/bjs.1800600817 PubMed 4541913

Formula version: Child-Pugh (Pugh 1973) · MediHelp calc v1.0.1

Formula and sources checked on 2026-10-29