This Child Pugh Score Calculator reveals the scoring system for the severity of chronic liver cirrhosis based on five key indicators. You can read more on this subject and get an interpretation of the results below the form.

Hepatic Encephalopathy

Ascites assessment

Bilirubin (mg/dL) clinical measure

Serum Albumin (g/dL) clinical measure

International normalized ratio (INR)

How does this Child Pugh Score Calculator work?

This is a health tool designed as a simple questionnaire with five questions, each with three choices that are awarded a system of points. It is based on the Child- Turcotte- Pugh score that assesses the prognosis of liver disease, in particular cirrhosis. This Child Pugh Score Calculator consists of five clinical liver factors and each measure has three stages and is awarded a score from 1 to 3 respectively.

The five measurements that are considered, the first two by clinical assessment and the rest of three by measurement are explained below:

■ Hepatic encephalopathy status – from none to grade III or IV. This kind of encephalopathy occurs when the liver is not able to remove toxins from the blood properly and those toxins remain in the circulation, throughout all organs and also affecting the nervous system.

Ascites assessment – from none to severe. Ascites is the condition in which fluid builds up between the peritoneum layers in the abdomen and one of its triggering causes is liver disfunction.

■ Bilirubin clinical measure – from less than 2 mg/dL to more than 3 mg/dL. This is a break down product resulted from the metabolism of old red blood cells and it is excreted through bile and urine. Elevated levels indicate amongst others that the liver may not function properly.

■ Serum albumin clinical measure – from less than 2.8 g/dL to more than 3.5 g/dL. This is one of the main blood proteins and carriers of other substances. Its levels are disrupted if the liver or kidneys are not functioning at their normal rate.

International Normalized Ratio (INR) – from less than 1.7 to more than 2.3. This is a measure of coagulation and rises when the liver is not able to produce clotting factors properly.

Medical interpretation and scores

Factor 1 point 2 points 3 points
Hepatic encephalopathy None Grade I-II Grade III-IV
Ascites None Mild Moderate to Severe
Total bilirubin (mg/dL) <2 2 - 3 >3
Serum albumin (g/L) >35 28-35 <28
PT INR <1.7 1.71-2.30 >2.30

The given for each of the five factors compose the final score which indicates one of the three classes that are in turn correlated to the first and second year survival percentages.

The first one, class A is indicative of a well compensated disease, the least severe case, class B indicated significant functional compromise while class C is the decompensate condition, the most severe liver disease.

  Class A Class B Class C
Total points 5 - 6 7 - 9 10 - 15
1 year survival 100% 81% 45%
2 year survival 85% 57% 35%

Conditions for which the Child Pugh Score is calculated

This score originated as a mortality tool in surgery but nowadays it is used for prognostic purposes, in determining the treatment strength and predicting the need for liver transplant.

It is often used in conjunction with the MELD score (the Model for End Stage Liver Disease) in order to prioritize liver transplant. Other medical conditions in which this score can be calculated are:

■ Ascites;
■ Alcoholic cirrhosis;
■ Biliary cirrhosis;
■ Cirrhosis from Hepatitis C virus;
■ Ruptured esophageal varices;
■ Primary sclerosing cholangitis.


1) Pugh RNH, Murray-Lyon IM, Dawson JL et al. (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg; 60:649-9.

2) Hyung JK, Hyun WL. (2013) Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol; 19(2): 105–115.

12 Jun, 2015