Child-Pugh Score Calculator

The Child-Pugh score — also called the Child-Turcotte-Pugh (CTP) score — grades how well a cirrhotic liver is functioning. It began as the Child and Turcotte classification in 1964 and was refined by Pugh and colleagues in 1973, who replaced the nutritional-status variable with prothrombin time and defined the numeric 1/2/3 point bands still used today. It remains one of the two standard liver-severity instruments taught and used alongside MELD.

1. Score each of the five variables 1, 2 or 3

• Total bilirubin— conventional: <2 mg/dL = 1, 2–3 = 2, >3 = 3. SI: <34 µmol/L = 1, 34–50 = 2, >50 = 3.
• Serum albumin— conventional: >3.5 g/dL = 1, 2.8–3.5 = 2, <2.8 = 3. SI: >35 g/L = 1, 28–35 = 2, <28 = 3.
• INR— <1.7 = 1, 1.7–2.3 = 2, >2.3 = 3. (Prothrombin-time-prolongation alternative: <4 s = 1, 4–6 s = 2, >6 s = 3.)
• Ascites — none = 1, mild / diuretic-responsive = 2, moderate–severe / refractory = 3.
• Hepatic encephalopathy — none = 1, grade I–II / medically controlled = 2, grade III–IV / refractory = 3.

2. Sum to a total and read the class

Add the five point values to a total of 5–15 and map it to a class: Class A = 5–6 (well compensated), Class B = 7–9 (significant compromise), Class C = 10–15 (decompensated). The middle band of every numeric variable is inclusive of both its endpoints exactly as Pugh published it, so a bilirubin of exactly 2.0 mg/dL or an albumin of exactly 3.5 g/dL each score 2, not 1. The calculator compares with a small tolerance so a value entered on a boundary lands in that documented middle band, and it re-derives the total through a second independent scoring path so a mistyped threshold would show up immediately.

The class-level 1- and 2-year survival figures shown (A ≈ 100% / 85%, B ≈ 80% / 60%, C ≈ 45% / 35%) are the widely-cited ranges from the AASLD/EASL cirrhosis literature, and the elective abdominal-surgery mortality (A ≈ 10%, B ≈ 30%, C ≈ 70–82%) is from Mansour and colleagues' 1997 series. They describe populations, not the specific patient in front of you, and are shown for orientation only. Some cholestatic diseases (for example primary biliary cholangitis) use higher bilirubin cut-offs; this tool applies the standard Pugh thresholds.

The three Child-Pugh classes with their class-level survival ranges and elective-surgery mortality. Treat these as orientation, not a patient-specific prognosis:

• Pugh RNH, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60(8):646–649
• Mansour A, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997;122(4):730–735
• AASLD — practice guidance on cirrhosis and its complications
• EASL — clinical practice guidelines on decompensated cirrhosis

The thresholds, the 5–15 point range and the A/B/C bands were last cross-checked against Pugh et al. (1973) on 2026-07-13, and the four worked examples were reconciled by hand against the original point table. This page is reviewed whenever the underlying guidance is revised.