Child-Pugh Score Calculator
Classify chronic liver disease severity (Class A/B/C) using bilirubin, albumin, INR, ascites, and encephalopathy. Estimates 1- and 2-year survival, guides surgical risk and transplant decisions.
Child-Pugh Class A
5/15
1-year survival 100% · 2-year survival 85%
Management
Well-compensated cirrhosis. Annual surveillance USG + AFP every 6 months for HCC. OGD for varices baseline. Routine vaccination (HAV, HBV, influenza, pneumococcus). Major surgery acceptable risk.
A full hepatology workflow in your pocket
EasyClinic auto-calculates Child-Pugh and MELD-Na on every LFT, tracks ascites, encephalopathy, and varices status, prompts 6-monthly HCC surveillance, and stores OGD reports — built for Indian liver clinics.
Also Known As
Components and points
5 parameters × 1-3 points each = total 5-15:
- Bilirubin (mg/dL): <2 = 1, 2-3 = 2, >3 = 3
- Albumin (g/dL): >3.5 = 1, 2.8-3.5 = 2, <2.8 = 3
- INR: <1.7 = 1, 1.7-2.3 = 2, >2.3 = 3
- Ascites: none = 1, mild/controlled = 2, refractory = 3
- Encephalopathy (West Haven): none = 1, grade 1-2 = 2, grade 3-4 = 3
Class and prognosis
- Class A (5-6): Well compensated. 1-year survival ~100%, 2-year ~85%.
- Class B (7-9): Significant functional compromise. 1-year ~80%, 2-year ~60%. Consider transplant evaluation.
- Class C (10-15): Decompensated. 1-year ~45%, 2-year ~35%. Urgent transplant consideration.
Surgical risk by Child-Pugh
- Class A: ~10% perioperative mortality — proceed with caution
- Class B: ~30% perioperative mortality — high risk, prefer non-operative if possible
- Class C: ~75% perioperative mortality — surgery contraindicated except life-saving
- For elective surgery, also compute MELD; MELD <10 generally safe, MELD >15 high risk
Child-Pugh vs MELD — when to use which
MELD-Na (creatinine, bilirubin, INR, sodium) is now the standard for transplant allocation because it is fully objective. Child-Pugh remains useful for: prognosis at the bedside, surgical risk, drug dosing (e.g. sorafenib, lenvatinib in HCC), and TIPS candidate selection.
Indian context
- Aetiology: NAFLD/NASH is now the #1 cause of cirrhosis in India (overtaking HBV/HCV in many centres) — INASL data 2023.
- Alcohol-related cirrhosis is rising, especially in men <50.
- HCC surveillance per INASL: 6-monthly USG abdomen ± AFP for all cirrhotics, regardless of cause.
- Transplant access in India: live-donor LT is more common than deceased donor; cost ₹25-30 lakhs at private centres, free at AIIMS/PGI.
Frequently Asked Questions
▸Why is my patient with Child A bleeding from varices?
Child-Pugh underestimates portal hypertension. Varices can develop and bleed at any class. Always do baseline OGD for varices at diagnosis, regardless of class.
▸How do I grade ascites if patient is on diuretics?
Score 2 if diuretic-controlled (no clinical ascites on furosemide+spironolactone). Score 3 if refractory (persistent despite max diuretics, or requiring LVP).
▸Should I use MELD or Child-Pugh for prognosis?
Both. MELD is better for short-term mortality (3-6 months) and transplant priority. Child-Pugh is better for surgical risk, drug dosing, and quick bedside assessment.
▸How often should I recompute Child-Pugh?
Every clinic visit (3-monthly for stable, monthly or sooner if decompensating). Class progression is one of the strongest signals to refer for transplant evaluation.
▸Does the score apply to acute liver failure?
No. Child-Pugh is for chronic liver disease. For ALF, use Kings College Criteria (paracetamol or non-paracetamol) and consider MELD.
▸What is the cost of LFT + INR in India?
Routine LFT panel ₹400-700, PT/INR ₹150-250 at NABL labs. Government hospitals offer free testing for registered patients.
References
- Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-9
- Cholongitas E et al. Systematic review: the model for end-stage liver disease — should it replace Child-Pugh? Aliment Pharmacol Ther 2005;22:1079-89
- AASLD Practice Guidance — Cirrhosis and its Complications 2021
- INASL (Indian National Association for Study of the Liver) Consensus Statement on Cirrhosis Care
- EASL Clinical Practice Guidelines: Decompensated Cirrhosis 2018
Track cirrhosis patients across every visit
EasyClinic auto-computes Child-Pugh and MELD-Na from each LFT, plots class progression, schedules HCC surveillance USG + AFP, and prompts variceal screening — your hepatology clinic, automated.
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