Child-Pugh Score Calculator

Child-Pugh uses 2 subjective parameters (ascites, encephalopathy) and 3 lab values; MELD uses only objective lab values (bilirubin, INR, creatinine; MELD-Na adds sodium). MELD-Na is the standard for liver-transplant prioritisation in most allocation systems and predicts 90-day mortality better than Child-Pugh. Child-Pugh remains very useful at the bedside for quick severity grading, surgical-risk discussion and TIPS candidacy.

In primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), bilirubin is chronically elevated out of proportion to other liver function. Pugh's original 1973 paper recommended raising the bilirubin cut-offs to <4 / 4–10 / >10 mg/dL in these conditions to avoid over-classifying patients. The other four parameters remain unchanged.

Mansour et al. (1997) and later series report 30-day post-operative mortality of roughly 10% in Child A, 30% in Child B and 75–82% in Child C for abdominal surgery. Class C is generally considered a relative contraindication to non-transplant elective surgery; class B requires careful pre-operative optimisation (ascites, encephalopathy, nutrition, INR) and intensive perioperative support. For ambulatory cholecystectomy and hernia repair, current guidance also factors in MELD <10.

No. In ACLF the prognosis is driven by extrahepatic organ failures (renal, circulatory, respiratory, cerebral). Use the CLIF-C ACLF score or AARC score (commonly used in India) for ACLF severity. Child-Pugh underestimates short-term mortality in this group.

Many drug labels (especially DOACs, statins, sorafenib, some antifungals and antibiotics) provide dosing guidance keyed to Child-Pugh class. For these, use the score as a prescribing reference. Note that "use with caution" or "avoid in Child-Pugh C" is a label-level statement — pharmacokinetic data in advanced cirrhosis are often limited, so individualise based on therapeutic-drug monitoring where possible.