Child-Pugh Score Calculator

How this Child-Pugh calculator helps

The Child-Pugh score is a practical bedside summary of liver function in chronic liver disease, especially cirrhosis. Rather than relying on a single laboratory result, it combines three lab measurements with two clinical findings that signal decompensation. The goal is not to replace clinical judgment. The goal is to turn several pieces of information into one consistent score that helps describe how advanced the disease appears at that moment. This page calculates that score from the most commonly used thresholds and reports the matching class: A, B, or C.

On this calculator, you enter total bilirubin in mg/dL, albumin in g/dL, INR, the current severity of ascites, and the current grade of hepatic encephalopathy. Each item contributes 1, 2, or 3 points. Higher totals indicate worse hepatic dysfunction. That simple structure is what makes the Child-Pugh system durable: it is easy to calculate, easy to explain, and easy to compare across visits when the same definitions are used consistently.

People often look up the Child-Pugh score when they want a quick description of cirrhosis severity, a rough sense of prognosis, or extra context around treatment planning. It is also commonly used in teaching because the variables map directly onto the physiology of liver disease: bilirubin reflects excretory function, albumin reflects synthetic function, INR reflects clotting factor production, and ascites plus encephalopathy capture two major clinical consequences of portal hypertension and hepatic failure. Used carefully, the score gives a compact picture of compensation versus decompensation.

What each input means

Total bilirubin measures how well the liver is processing and excreting bilirubin. In the standard version used here, values below 2 mg/dL receive 1 point, values from 2 to 3 mg/dL receive 2 points, and values above 3 mg/dL receive 3 points. If your laboratory reports bilirubin in micromoles per liter, convert before entry. A quick approximation is that mg/dL is the micromoles per liter value divided by 17.1. Enter the converted number rather than the original lab unit so the score is applied correctly.

Albumin is a protein produced by the liver. Lower albumin suggests weaker synthetic function and is associated with more advanced disease. This calculator uses the standard cutoffs of greater than 3.5 g/dL for 1 point, 2.8 to 3.5 g/dL for 2 points, and less than 2.8 g/dL for 3 points. If your lab reports albumin in g/L, divide by 10 before entering it here. Albumin is one of the clearest examples of why units matter: a value of 32 g/L is not thirty-two g/dL; it is 3.2 g/dL and scores 2 points.

INR reflects blood clotting and is used here as a marker of liver synthetic function. Lower INR values receive fewer points; higher values receive more. In this calculator, INR below 1.7 scores 1 point, 1.7 to 2.3 scores 2 points, and above 2.3 scores 3 points. Because INR can be affected by anticoagulants and other clinical factors, interpret it in context. The calculator will still compute the score exactly as entered, but the medical meaning may be more complicated if the INR is being altered for reasons other than liver function alone.

Ascites is a clinical assessment rather than a lab value. Choose No ascites for 1 point, Mild or controlled for 2 points, and Moderate to severe for 3 points. This is one of the subjective parts of the Child-Pugh system, so it helps to use the same clinical standard each time you compare scores over time. A patient whose ascites is controlled with diuretics is not scored the same way as a patient with tense or refractory ascites.

Encephalopathy is also a clinical rating. Select No encephalopathy for 1 point, Grade 1–2 for 2 points, and Grade 3–4 for 3 points. This input is intended to reflect the current clinical severity of hepatic encephalopathy, not a remote history that is no longer present. Mild confusion or sleep disturbance is treated differently from marked disorientation or coma, and that difference changes the score.

One practical tip matters more than any spreadsheet trick: use values from the same clinical window. Do not combine a bilirubin from several weeks ago with an INR from today and a bedside assessment from a different hospitalization. The Child-Pugh score is most meaningful when the five inputs describe the same patient state.

How the score is calculated

The Child-Pugh total is the sum of five component scores. Each criterion contributes either 1, 2, or 3 points, so the minimum possible total is 5 and the maximum is 15. That detail is useful for sanity checking. If you ever see a Child-Pugh total of 0 or 4, you know immediately that something was entered or interpreted incorrectly, because every category contributes at least one point.

Once the total score S is known, the class is assigned by range:

More generally, any calculator can be described as a function of several inputs. The two MathML blocks below state that general idea and are preserved here because they accurately describe the underlying structure of the computation.

For Child-Pugh specifically, the weighting is especially simple: each variable contributes one of three discrete point levels. The result is easy to reproduce by hand, which is a good reason to sanity check the calculator output against the individual point assignments if a result surprises you.

Standard point assignments used by this calculator

The thresholds above are the ones implemented in the JavaScript below. If your clinical setting uses a different bilirubin variant for certain cholestatic disorders, be aware that this page does not switch thresholds automatically. It applies the common standard table exactly as shown.

Worked example

Suppose a patient has a bilirubin of 2.6 mg/dL, albumin of 3.1 g/dL, INR of 1.5, mild controlled ascites, and no encephalopathy. The score is built one criterion at a time. Bilirubin of 2.6 mg/dL receives 2 points. Albumin of 3.1 g/dL receives 2 points. INR of 1.5 receives 1 point. Mild ascites receives 2 points. No encephalopathy receives 1 point. Add them together and the total is 8.

A total of 8 falls in the 7 to 9 range, so the patient is Child-Pugh class B. The result does not mean that every patient with class B cirrhosis will behave the same way. It means the patient belongs to the middle severity group in this scoring system, with more impairment than class A and less than class C. That is the right level of interpretation for a bedside score: it is a compact summary, not a full diagnosis in one number.

Scenario testing can also be helpful. If everything in that example stays the same but the encephalopathy changes from none to grade 1–2, the total rises from 8 to 9 and the class remains B. If the INR also rises into the next point bracket, the total can cross from 9 to 10 and the class changes to C. That is an important lesson hidden inside the score: some patients sit close to a class boundary, so one additional point can move them into a different category even when the overall clinical picture seems only modestly worse.

How to interpret the result

Class A corresponds to a total score of 5 or 6. This generally reflects compensated cirrhosis or comparatively preserved hepatic function within the Child-Pugh framework. Patients in this range may still have meaningful liver disease, but they are not at the same level of decompensation as higher classes.

Class B corresponds to a total score of 7 to 9. This range suggests more substantial functional compromise. It is the class where many patients are clearly beyond well-compensated disease but not yet at the extreme end of the scale. Close monitoring, optimization of complications, and specialist follow-up become especially important here.

Class C corresponds to a total score of 10 to 15. This is the most severe group in the system and signals decompensated cirrhosis with high risk of complications. In real practice, this result should prompt careful hepatology assessment and complication management. It is also the range where quick bedside scores should never be used in isolation; the clinical picture is usually too important and too dynamic for a single score to carry the full decision.

A good result review is specific, not vague. Confirm that bilirubin and albumin were entered in the correct units, remember that the score must land between 5 and 15, and check whether the class fits the component points you can see on the table. If a patient has mostly 1-point entries with no major decompensating features, a class C result would be a red flag for incorrect data entry. Likewise, multiple 3-point entries should never lead to a class A result.

Important assumptions and limitations

The Child-Pugh system is widely used because it is simple, but that simplicity comes with tradeoffs. Ascites and encephalopathy are partly subjective, so two clinicians can occasionally score the same patient differently. INR can be influenced by anticoagulation or factors other than liver function. Bilirubin thresholds may be adapted in some disease subtypes, while this calculator uses the standard thresholds coded on the page. These are not flaws in the calculator so much as reminders that the model is only as clean as the clinical inputs.

This score is also not the only way to assess liver disease severity. It does not replace MELD-based assessment, transplant evaluation, or disease-specific judgment. It should not be used as a stand-alone tool for acute liver failure, emergency triage, medication safety, or prognosis counseling without broader clinical context. Think of it as one structured summary among several, useful because it is transparent and reproducible.

Still, that transparency is a real strength. Because the score is just five inputs added together, you can see exactly what is driving the class. If the number changes over time, you can usually identify why: bilirubin worsened, albumin fell, encephalopathy appeared, ascites became harder to control, or INR moved into a higher bracket. That makes the Child-Pugh score helpful not only for categorization, but also for communication.