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Child-Pugh Score Calculator

Child-Turcotte-Pugh scoring for cirrhosis severity, surgical risk and 1- and 2-year survival estimates. Calculations run locally in your browser.

In primary biliary cholangitis and primary sclerosing cholangitis, bilirubin cut-offs are raised to <4 / 4–10 / >10 mg/dL (Pugh 1973).

Laboratory values

Clinical findings

Child-Pugh Score

Disclaimer: The Child-Pugh score is a prognostic tool, not a diagnosis. It does not capture renal dysfunction, hyponatraemia or variceal bleeding — for transplant prioritisation, MELD-Na has largely replaced Child-Pugh. Surgical and TIPS decisions must integrate the full clinical picture (MELD, platelets, hepatic venous pressure gradient, frailty, comorbidities) and senior hepatology input.

Frequently asked questions

How does Child-Pugh compare with MELD / MELD-Na?

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.

When do I apply the cholestatic-disease cut-offs?

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.

What does the score mean for elective surgery?

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.

Is Child-Pugh useful in acute-on-chronic liver failure (ACLF)?

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.

Can I use Child-Pugh to dose-adjust drugs?

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.

References

  1. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60(8):646–649.
  2. Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. Philadelphia: WB Saunders; 1964:50–64.
  3. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997;122(4):730–735.
  4. Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology 2021;161(6):1887–1895.
  5. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69(2):406–460.
  6. INASL Position Statement on Acute-on-Chronic Liver Failure. Indian National Association for Study of the Liver; 2019.

Survival estimates from Pugh (1973) and Infante-Rivard (1987). Surgical mortality estimates from Mansour et al. (1997). Always defer to your hepatology and surgical team's local protocols.

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