{
  "id": "child-pugh",
  "version": "9dc229662a40",
  "status": "published",
  "name": "Child-Pugh Calculator",
  "question": "What is my Child-Pugh class?",
  "summary": "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.",
  "category": "health",
  "subcategory": "clinical",
  "url": "https://www.acalculator.org/health/child-pugh-calculator",
  "markdown": "https://www.acalculator.org/health/child-pugh-calculator.md",
  "kind": "function",
  "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.",
  "assumptions": [
    "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)."
  ],
  "inputs": {
    "$schema": "https://json-schema.org/draft/2020-12/schema",
    "type": "object",
    "properties": {
      "units": {
        "title": "Lab units",
        "description": "US units (bilirubin mg/dL, albumin g/dL) or SI units (bilirubin µmol/L, albumin g/L).",
        "type": "string",
        "enum": [
          "us",
          "si"
        ]
      },
      "bili": {
        "title": "Bilirubin (mg/dL)",
        "description": "Total serum bilirubin, in mg/dL.",
        "type": "number",
        "minimum": 0.1,
        "maximum": 80
      },
      "biliSi": {
        "title": "Bilirubin (µmol/L)",
        "description": "Total serum bilirubin, in µmol/L.",
        "type": "number",
        "minimum": 1.7,
        "maximum": 1368
      },
      "alb": {
        "title": "Albumin (g/dL)",
        "description": "Serum albumin, in g/dL.",
        "type": "number",
        "minimum": 0.5,
        "maximum": 7
      },
      "albSi": {
        "title": "Albumin (g/L)",
        "description": "Serum albumin, in g/L.",
        "type": "number",
        "minimum": 5,
        "maximum": 70
      },
      "inr": {
        "title": "INR",
        "description": "International normalized ratio of the prothrombin time.",
        "type": "number",
        "minimum": 0.5,
        "maximum": 15
      },
      "ascites": {
        "title": "Ascites",
        "description": "Fluid in the belly: none, mild (or controlled with medicine), or moderate to severe.",
        "type": "string",
        "enum": [
          "none",
          "mild",
          "severe"
        ]
      },
      "enceph": {
        "title": "Encephalopathy",
        "description": "Hepatic encephalopathy (confusion from liver disease): none, grade 1 to 2, or grade 3 to 4.",
        "type": "string",
        "enum": [
          "none",
          "mild",
          "severe"
        ]
      },
      "cholestatic": {
        "title": "PBC or PSC",
        "description": "Primary biliary cholangitis or primary sclerosing cholangitis, which use higher bilirubin bands.",
        "type": "boolean"
      }
    }
  },
  "outputs": {
    "score": {
      "label": "Child-Pugh score",
      "description": "The total of the five items, 5 to 15.",
      "format": "integer"
    },
    "childClass": {
      "label": "Class",
      "description": "Class A (5 to 6), B (7 to 9), or C (10 to 15).",
      "format": "text"
    },
    "parts": {
      "label": "Points per item",
      "description": "The points for each of the five items.",
      "format": "text"
    }
  },
  "defaultAnswer": {
    "inputs": {
      "units": "us",
      "bili": 1.5,
      "biliSi": 26,
      "alb": 3.2,
      "albSi": 32,
      "inr": 1.4,
      "ascites": "mild",
      "enceph": "none",
      "cholestatic": false
    },
    "outputs": {
      "score": 7,
      "childClass": "Class B",
      "parts": "bilirubin 1, albumin 2, INR 1, ascites 2, encephalopathy 1"
    },
    "text": "The Child-Pugh score is 7 (Class B)."
  },
  "examples": [
    {
      "given": {
        "units": "us",
        "bili": 1.5,
        "alb": 3.2,
        "inr": 1.4,
        "ascites": "mild",
        "enceph": "none",
        "cholestatic": false
      },
      "expect": {
        "score": 7,
        "childClass": "Class B",
        "parts": "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 (hand calculation in content.mdx)"
    },
    {
      "given": {
        "units": "us",
        "bili": 1,
        "alb": 4,
        "inr": 1,
        "ascites": "none",
        "enceph": "none",
        "cholestatic": false
      },
      "expect": {
        "score": 5,
        "childClass": "Class A"
      },
      "source": "Pugh et al. 1973: every item scores 1, total 5, class A (hand calculation)"
    },
    {
      "given": {
        "units": "si",
        "biliSi": 60,
        "albSi": 25,
        "inr": 2.5,
        "ascites": "severe",
        "enceph": "severe",
        "cholestatic": false
      },
      "expect": {
        "score": 15,
        "childClass": "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 (hand calculation)"
    },
    {
      "given": {
        "units": "us",
        "bili": 3,
        "alb": 3.5,
        "inr": 1.7,
        "ascites": "none",
        "enceph": "mild",
        "cholestatic": false
      },
      "expect": {
        "score": 9,
        "childClass": "Class B",
        "parts": "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 (hand calculation in content.mdx)"
    },
    {
      "given": {
        "units": "us",
        "bili": 5,
        "alb": 3.6,
        "inr": 1.2,
        "ascites": "none",
        "enceph": "none",
        "cholestatic": true
      },
      "expect": {
        "score": 6,
        "childClass": "Class A",
        "parts": "bilirubin 2, albumin 1, INR 1, ascites 1, encephalopathy 1"
      },
      "source": "PBC and PSC bilirubin bands (under 4, 4 to 10, over 10 mg/dL): 5 mg/dL scores 2; total 6, class A (hand calculation)"
    }
  ],
  "sources": [
    "Pugh RNH, 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. https://doi.org/10.1002/bjs.1800600817",
    "Child CG, Turcotte JG. Surgery and portal hypertension. In: Child CG, ed. The Liver and Portal Hypertension. Philadelphia: Saunders; 1964:50-64.",
    "Tsoris A, Marlar CA. Use of the Child Pugh score in liver disease. StatPearls. StatPearls Publishing; updated 2023. https://www.ncbi.nlm.nih.gov/books/NBK542308/ (INR bands, PBC and PSC bilirubin bands)"
  ],
  "related": [],
  "changelog": [
    {
      "date": "2026-09-29",
      "note": "Published after this site's editorial review against the cited sources (no clinician review); the page notice says so."
    }
  ]
}