Child-Pugh Score
If you have advanced liver disease, your healthcare provider might calculate your Child-Pugh score to help them determine how severe it is. The score adds up various medical tests results to provide a snapshot of your overall liver health. Healthcare providers use it to help make decisions about your treatment plan.
What is the Child-Pugh score?
The Child-Pugh score is a scoring system that helps healthcare providers rate how severe your liver disease is. It helps show how well your liver is still functioning, how close you are to liver failure and what treatment to recommend (like a liver transplant). Providers calculate your score based on various medical test results. The score helps them communicate about your condition in a consistent way.
It’s also called Child-Turcotte-Pugh score.
What factors do they look at?
The Child-Pugh score uses five medical data points to determine how advanced your condition is:
- Total bilirubin in your blood
- Serum albumin levels in your blood
- How quickly your blood clots (prothrombin time or INR)
- If there’s extra fluid in your abdomen (ascites)
- If liver disease is changing how your brain works (hepatic encephalopathy)
Each of these factors receives a point value (from one to three) based on your test results. Your provider adds up the total number and uses this score to assign you a classification.
Child-Pugh classification
Your Child-Pugh score will assign you a classification based on how well your liver is functioning:
- Class A: Normal liver function
- Class B: Reduced liver function
- Class C: Severe liver dysfunction
When is the Child-Pugh score used?
Your provider might want to calculate your Child-Pugh score if you have cirrhosis of the liver. This is a late stage of chronic liver disease that develops after many years. Having cirrhosis means you have irreversible liver damage. At this stage, your liver might start to have trouble functioning as it should.
How do I get my Child-Pugh score?
Getting your Child-Pugh score involves having a physical exam, blood tests and imaging tests. These tests may happen at different places and on different days.
Your healthcare provider will ask to draw a blood sample so they can get results for your:
- Bilirubin levels: Bilirubin is a compound in bile, a product your liver makes
- Albumin levels: Albumin is an important protein your liver makes
- Prothrombin time (PT) or INR: Your liver plays a role in how fast your blood clots
Your provider may use imaging tests like an abdominal ultrasound or a CT scan to look for excess fluids collecting in your abdomen (ascites). This can happen when you have advanced liver disease.
Testing for encephalopathy (cognitive impairment) may involve having a cognitive exam. Encephalopathy can happen when toxins build up in your blood due to liver damage.
Once your provider has all the test results, they’ll use them to calculate your Child-Pugh score.
What does your Child-Pugh score tell you?
Your Child-Pugh score provides a snapshot of how severe your liver disease is. It helps your provider:
- Guide your treatment plan: Your score can help them decide if medications, surgery or a liver transplant would be beneficial for you.
- Assess risks and benefits: Your score can help them decide how risky or beneficial surgery would be to your overall health and predict your quality of life after surgery.
- Predict your prognosis: While survival rates are only estimates, your provider can use your score to predict your mortality risk — if and how long you’d survive with or without treatment.
When should I call my healthcare provider?
Contact your healthcare provider if you have any questions about your score and how it was calculated. Talk to your provider if you have concerns about the results or what comes next in your treatment plan.
How is my Child-Pugh score calculated?
Your healthcare provider will look at all of your test results and assign a score for each of the five factors they’re assessing. For each factor, you can receive either one, two or three points. (One point is the least severe and three points is the most severe.)
Once each of the five factors has a score, your provider will add up the total. You’ll receive a total score of between five and 15. That’s your Child-Pugh score.
This chart shows how a Child-Pugh score is calculated based on the results of each of the five factors:
|
Factor
|
1 Point
|
2 Point
|
3 Point
|
|---|---|---|---|
|
Bilirubin in milligrams per deciliter (mg/dL)
|
<2 mg/dL
|
2 to 3 mg/dL
|
>3 mg/dL
|
|
Albumin in grams per deciliter (g/dL)
|
>3.5 g/dL
|
2.8 to 3.5 g/dL
|
<2.8 g/dL
|
|
Prothrombin time (PT) / INR (international normalized ratio)
|
<4 / <1.7
|
4 to 6 / 1.7-2.3
|
>6 / >2.3
|
|
Ascites
|
None
|
Slight
|
Moderate
|
|
Encephalopathy
|
None
|
Grade 1 to 2
|
Grade 3 to 4
|
Based on your total score, you’ll fall into one of three classifications:
- Class A (your liver is working normally): Overall score between five and six points
- Class B (there’s moderate liver damage): Overall score between seven and nine points
- Class C (there’s severe or advanced liver damage): Overall score between 10 and 15 points
References
- El-Khateeb E, Darwich AS, Achour B, Athwal V, Rostami-Hodjegan A. Review article: time to revisit Child-Pugh score as the basis for predicting drug clearance in hepatic impairment (https://pubmed.ncbi.nlm.nih.gov/34218453/). Aliment Pharmacol Ther. 2021 Aug;54(4):388-401. Accessed 8/22/2025.
- Peng Y, Qi X, Guo X. Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies (https://pubmed.ncbi.nlm.nih.gov/26937922/). Medicine (Baltimore). 2016 Feb;95(8):e2877. Accessed 8/22/2025.
- Tsoris A, Marlar CA. Use Of The Child Pugh Score In Liver Disease (https://www.ncbi.nlm.nih.gov/books/NBK542308/). 2023 Mar 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Accessed 8/22/2025.
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