What is my Child-Pugh class?
Enter bilirubin, albumin, and INR, in US or SI units, and pick the level of ascites and encephalopathy to get the Child-Pugh score and class. For information only. This is not medical advice or a diagnosis. Do not use it to make treatment decisions without a clinician. No licensed clinician has reviewed this page.
- Child-Pugh score
- 7
The Child-Pugh score is 7 (Class B).
Class B
- Class A
- Class B
- Class C
- Class
- Class B
- Points per item
- bilirubin 1, albumin 2, INR 1, ascites 2, encephalopathy 1
Child-Pugh score: 7. The Child-Pugh score is 7 (Class B).
Which class?
This calculator gives general information only. It is not medical advice and does not replace a doctor or other health care provider. Talk with a professional about your results. Terms of use
How to calculate
Adds up the Child-Pugh score (Pugh 1973) for chronic liver disease from bilirubin, albumin, INR, ascites, and encephalopathy, in US or SI units, and shows class A, B, or C.
Example with the default inputs (Lab units US, Bilirubin (mg/dL) 1.5, Albumin (g/dL) 3.2, INR 1.4, Ascites Mild, Encephalopathy None, PBC or PSC No): The Child-Pugh score is 7 (Class B).
Method: Score = points for bilirubin + albumin + INR + ascites + encephalopathy, each 1 to 3; class A 5 to 6, B 7 to 9, C 10 to 15.
- Bands are applied in the unit you pick: bilirubin under 2, 2 to 3, over 3 mg/dL (under 34, 34 to 50, over 50 µmol/L); PBC and PSC under 4, 4 to 10, over 10 mg/dL (under 68, 68 to 170, over 170 µmol/L).
- Albumin over 3.5, 2.8 to 3.5, under 2.8 g/dL (over 35, 28 to 35, under 28 g/L). INR under 1.7, 1.7 to 2.3, over 2.3. A value on a band edge scores the middle band.
- INR stands in for the prothrombin time prolongation of the 1973 paper (1 to 4, 4 to 6, over 6 seconds).
Worked examples
Each example is checked against the calculator on every build.
- Lab units US, Bilirubin (mg/dL) 1.5, Albumin (g/dL) 3.2, INR 1.4, Ascites Mild, Encephalopathy None, PBC or PSC no gives Child-Pugh score 7, Class Class B, Points per item bilirubin 1, albumin 2, INR 1, ascites 2, encephalopathy 1.Source: Pugh et al., Br J Surg 1973 point table: 1 + 2 + 1 + 2 + 1 = 7, class B
- Lab units US, Bilirubin (mg/dL) 1, Albumin (g/dL) 4, INR 1, Ascites None, Encephalopathy None, PBC or PSC no gives Child-Pugh score 5, Class Class A.Source: Pugh et al. 1973: every item scores 1, total 5, class A ()
- Lab units SI, Bilirubin (µmol/L) 60, Albumin (g/L) 25, INR 2.5, Ascites Moderate to severe, Encephalopathy Grade 3 to 4, PBC or PSC no gives Child-Pugh score 15, Class Class C.Source: Pugh et al. 1973 SI bands: bilirubin over 50 µmol/L 3, albumin under 28 g/L 3, INR over 2.3 3, 3, 3 = 15 ()
- Lab units US, Bilirubin (mg/dL) 3, Albumin (g/dL) 3.5, INR 1.7, Ascites None, Encephalopathy Grade 1 to 2, PBC or PSC no gives Child-Pugh score 9, Class Class B, Points per item bilirubin 2, albumin 2, INR 2, ascites 1, encephalopathy 2.Source: Pugh et al. 1973: bilirubin 3.0, albumin 3.5, and INR 1.7 sit on band edges and score 2 each
- Lab units US, Bilirubin (mg/dL) 5, Albumin (g/dL) 3.6, INR 1.2, Ascites None, Encephalopathy None, PBC or PSC yes gives Child-Pugh score 6, Class Class A, Points per item bilirubin 2, albumin 1, INR 1, ascites 1, encephalopathy 1.
Medical disclaimer
This calculator is for information and education only. It is not medical advice, and its result is not a diagnosis. Do not use it to start, stop, or change a treatment without a clinician who knows your health history. No licensed clinician has reviewed this page. This site's editors checked the formulas and worked examples against published sources. If you think you have a medical emergency, call your local emergency number.
When this does not apply. The score is for adults with cirrhosis (Pugh 1973). The ascites and encephalopathy grades need a clinician's examination. The score does not apply to acute liver failure.
How the score is worked out
Each item scores 1, 2, or 3 points. A value on a band edge scores the middle band (2 points).
| Item | 1 point | 2 points | 3 points |
|---|---|---|---|
| Bilirubin, mg/dL (µmol/L) | under 2 (under 34) | 2 to 3 (34 to 50) | over 3 (over 50) |
| Bilirubin in PBC or PSC, mg/dL (µmol/L) | under 4 (under 68) | 4 to 10 (68 to 170) | over 10 (over 170) |
| Albumin, g/dL (g/L) | over 3.5 (over 35) | 2.8 to 3.5 (28 to 35) | under 2.8 (under 28) |
| INR | under 1.7 | 1.7 to 2.3 | over 2.3 |
| Ascites | none | mild, or controlled with medicine | moderate to severe |
| Encephalopathy | none | grade 1 to 2 | grade 3 to 4 |
The bands are applied in the unit you pick, with the SI numbers in brackets; the page does not convert between units. The SI bilirubin bands are the rounded values that most tables use (2 mg/dL × 17.1 = 34.2 µmol/L).
Score = the sum of the five items, 5 to 15.
| Score | Class |
|---|---|
| 5 to 6 | A |
| 7 to 9 | B |
| 10 to 15 | C |
The "points per item" row shows each item's points.
Worked examples by hand
The default. Bilirubin 1.5 mg/dL (1), albumin 3.2 g/dL (2), INR 1.4 (1), mild ascites (2), no encephalopathy (1): 1 + 2 + 1 + 2 + 1 = 7, class B.
All normal. Bilirubin 1.0, albumin 4.0, INR 1.0, no ascites, no encephalopathy: 5, class A.
SI units, severe. Bilirubin 60 µmol/L (over 50: 3), albumin 25 g/L (under 28: 3), INR 2.5 (3), moderate to severe ascites (3), grade 3 to 4 encephalopathy (3): 15, class C.
On the band edges. Bilirubin 3.0 (2), albumin 3.5 (2), INR 1.7 (2), no ascites (1), grade 1 to 2 encephalopathy (2): 9, class B.
PBC. Bilirubin 5 mg/dL with the PBC bands (4 to 10: 2), albumin 3.6 (1), INR 1.2 (1), no ascites (1), no encephalopathy (1): 6, class A.
Other questions people ask
What is the Child-Pugh score?
The Child-Pugh score (also Child-Turcotte-Pugh) grades how severe chronic liver disease, usually cirrhosis, is. Child and Turcotte proposed it in 1964, and Pugh and others revised it in 1973. Five items each score 1 to 3 points, for a total of 5 to 15.
What do the Child-Pugh classes mean?
Class A (5 to 6 points) is well-compensated disease, class B (7 to 9) is significant loss of liver function, and class C (10 to 15) is decompensated disease. The class helps clinicians judge the outlook, the risk of surgery, and how the liver may handle some medicines.
What is the difference between Child-Pugh and MELD?
MELD uses only lab values and is used to rank patients for a liver transplant in the US. Child-Pugh also includes two clinical signs (ascites and encephalopathy) that a clinician judges. Many clinicians look at both.
Why is INR used instead of prothrombin time?
The 1973 paper scored the prothrombin time in seconds above normal (1 to 4, 4 to 6, over 6). Seconds vary between labs, so most tables now use the INR bands under 1.7, 1.7 to 2.3, and over 2.3.
Why are there different bilirubin bands for PBC and PSC?
In primary biliary cholangitis and primary sclerosing cholangitis, bilirubin rises early in the disease, so the usual bands would overstate severity. Tables for these conditions use under 4, 4 to 10, and over 10 mg/dL.