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Child-Pugh Score for Cirrhosis

Child-Pugh grades cirrhosis severity from bilirubin, albumin, INR, ascites and encephalopathy (5–15 points): class A 5–6 (well compensated), B 7–9 (significant functional compromise), C 10–15 (decompensated). It guides prognosis, drug dosing and surgical risk.

  • Total bilirubin (mg/dL or µmol/L)
  • Serum albumin (g/dL or g/L)
  • INR
  • Ascites: None (1); Mild (slight, or controlled with diuretics) (2); Moderate–severe (tense or refractory) (3)
  • Hepatic encephalopathy: None (1); Grade 1–2 (or controlled with medication) (2); Grade 3–4 (or refractory) (3)
  • Cholestatic disease (PBC/PSC): use bilirubin cut-offs 4 and 10 mg/dL (yes/no)
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Interpretation

ResultMeaning
5–6Class A: well compensated
7–9Class B: significant functional compromise
10–15Class C: decompensated

Formula

Bilirubin <2 / 2–3 / >3 mg/dL (<34 / 34–50 / >50 µmol/L) = 1/2/3 (PBC/PSC: <4 / 4–10 / >10). Albumin >3.5 / 2.8–3.5 / <2.8 g/dL = 1/2/3. INR <1.7 / 1.7–2.3 / >2.3 = 1/2/3. Ascites none / mild / moderate–severe = 1/2/3. Encephalopathy none / grade 1–2 / grade 3–4 = 1/2/3.

Clinical pearls

  • Ascites and encephalopathy grading is subjective; MELD is more reproducible for transplant prioritisation.
  • Bilirubin is compared after rounding to 0.1 mg/dL, so 34 µmol/L (2.0 mg/dL) scores 2 points.
  • Pugh's 1973 modification used prothrombin time prolongation (1–4 / 4–6 / >6 s); INR cut-offs 1.7 and 2.3 are the standard modern substitute.

Examples

child pugh bili 2.4 alb 3.0 inr 1.8 mild ascites no encephalopathyChild-Pugh score: bilirubin 50 umol/L, albumin 26 g/L, INR 2.5, tense ascites, grade 2 encephalopathyctp class for cirrhosis bili 1.1 albumin 4.0 inr 1.1 no ascites no he

FAQ

What is Child-Pugh class B?

A score of 7–9 points: significant functional compromise. Many drugs need dose reduction and elective surgery carries substantially higher risk.

Child-Pugh or MELD?

Child-Pugh is quick and guides drug dosing and surgical risk; MELD is objective, continuous and used for transplant allocation.

Evidence

  1. Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–9.

Hepatology & GI · Reviewed 2026-10-14 · Methodology