Child-Pugh Calculator
Classify cirrhosis severity from five standard clinical and laboratory criteria, with a transparent point breakdown and downloadable Excel record.
Clinical inputs
Live result
Point breakdown
| Criterion | Current selection | Points |
|---|---|---|
| Total bilirubin | 2.4 mg/dL | 2 |
| Serum albumin | 2.8 – 3.5 g/dL (28 – 35 g/L) | 2 |
| INR | < 1.7 | 1 |
| Ascites | Slight / medically controlled | 2 |
| Hepatic encephalopathy | None | 1 |
How to use the Child-Pugh calculator
What this calculator does
The Child-Pugh score combines five clinical and laboratory criteria to summarize the severity of cirrhosis. Each criterion receives 1, 2, or 3 points, and the five values are added to a total from 5 to 15. Totals of 5 – 6 are class A, 7 – 9 are class B, and 10 – 15 are class C. The result is a clinical classification, not a diagnosis and not an individualized survival prediction. It is most useful when the underlying measurements and clinical assessments are current and have been interpreted by a qualified clinician. The NHS Specialist Pharmacy Service Child-Pugh guidance describes the same five-parameter structure and class bands.
When to use it
Typical uses include summarizing cirrhosis severity during a clinical review, documenting a current liver-function class for multidisciplinary discussion, checking the Child-Pugh category referred to in medicine information, and comparing the score after a meaningful change in clinical status. It should not be used by itself to decide on surgery, transplantation, medication dosing, or prognosis. Ascites and encephalopathy are partly subjective, and modern decision-making may use other scores alongside the Child-Pugh classification.
How to calculate
- The calculator opens with a complete demonstration: bilirubin 2.4 mg/dL, albumin 2.8 – 3.5 g/dL, INR below 1.7, slight or medically controlled ascites, and no hepatic encephalopathy. The example produces 8 points, class B, and the Excel download is available immediately.
- Replace the demonstration values with the current assessment. For bilirubin, type the numeric result and choose mg/dL or µmol/L. Changing the bilirubin unit converts the displayed value rather than only changing its label.
- Select the measured Serum albumin range and International Normalized Ratio (INR) range, then select the clinical Ascites and Hepatic encephalopathy categories.
- Read the live Child-Pugh score, class, interpretation, typical survival percentages, and the point breakdown. The breakdown makes it clear which 1 – 3 point category was assigned to each criterion.
- Select Download Excel to create an .xlsx workbook from the current validated model. Reset clears the demonstration and all result state; because the cleared state is incomplete, Excel export is then disabled until a complete valid set of inputs is entered again.
Input guide
Total bilirubin is required and accepts a positive decimal number in the selected unit. In mg/dL, values below 2 score 1 point, 2 through 3 score 2 points, and values above 3 score 3 points. In µmol/L, the corresponding bands are below 34.2, 34.2 through 51.3, and above 51.3. An example is 2.4 mg/dL. The parser uses a period as the decimal separator; comma decimals, mixed units, negative values, and scientific notation are rejected rather than silently reinterpreted. Higher bilirubin bands increase the score.
Total bilirubin unit is required and offers mg/dL or µmol/L. Switching units converts the current valid numeric value using 1 mg/dL = 17.1 µmol/L for this interface. The scoring bands remain equivalent after conversion. A common mistake is to paste a value with its unit into the numeric box; enter only the number and use the unit control.
Serum albumin is required and is selected as >3.5 g/dL (>35 g/L), 2.8 – 3.5 g/dL (28 – 35 g/L), or <2.8 g/dL (<28 g/L). These ranges score 1, 2, and 3 points respectively. The demonstration uses the middle band. Lower albumin therefore increases the score. Choose the range containing the measured value rather than estimating a category from a different protein measurement.
International Normalized Ratio (INR) is required. Select <1.7, 1.7 – 2.3, or >2.3, corresponding to 1, 2, or 3 points. The example uses <1.7. Higher INR bands increase the score. INR and prothrombin-time prolongation are alternative ways of representing this criterion in common Child-Pugh tables; do not add both as separate criteria.
Ascites is required and uses three clinical categories: Absent, Slight / medically controlled, or Moderate to severe / refractory. They contribute 1, 2, or 3 points. The demonstration uses slight/controlled ascites. This is a clinical assessment, so a common error is to treat the choice as a purely laboratory threshold. Response to treatment is part of the usual interpretation.
Hepatic encephalopathy is required and uses None, Grade 1 – 2, or Grade 3 – 4, again worth 1, 2, or 3 points. The demonstration uses None. The NCBI overview of Child-Pugh scoring summarizes these category assignments and the historical basis of the score. Clinical grading should reflect the current assessment rather than a past worst episode unless the clinical context specifically calls for that.
Output guide
Child-Pugh score is the exact sum of the five component points and ranges from 5 to 15. Child-Pugh class converts that total into A for 5 – 6, B for 7 – 9, or C for 10 – 15. Interpretation labels the class as well-functioning/compensated, significant functional compromise, or decompensated liver disease. Typical 1-year survival and Typical 2-year survival show the commonly cited class-level figures used in this calculator: 100%/85% for A, 80%/60% for B, and 45%/35% for C. These percentages are historical class-level estimates, not a personalized forecast. The Point breakdown table lists Criterion, Current selection, and Points; its five point values add exactly to the displayed total.
Worked example
With the startup values, bilirubin 2.4 mg/dL falls in the 2 – 3 mg/dL band for 2 points. Albumin 2.8 – 3.5 g/dL adds 2 points. INR below 1.7 adds 1 point. Slight or medically controlled ascites adds 2 points, and no encephalopathy adds 1 point. The arithmetic is 2 + 2 + 1 + 2 + 1 = 8 points. A total of 8 falls in the 7 – 9 band, so the first-open result is Child-Pugh class B, described here as significant functional compromise, with the displayed typical survival figures of 80% at one year and 60% at two years.
Understanding the score
The Child-Pugh system is intentionally compact: it compresses bilirubin, albumin, coagulation status, ascites, and encephalopathy into three-point ordinal bands. That simplicity makes it easy to communicate, but it also means two patients with different raw laboratory values can receive the same point total. The University of Washington Hepatitis C Online CTP calculator presents the same standard category thresholds for bilirubin, albumin, INR, ascites, and encephalopathy.
Because ascites and encephalopathy rely on clinical grading, changes in those observations can alter the score even when laboratory values are unchanged. Conversely, a large change inside one numerical band does not change the point contribution until a threshold is crossed. That is why the total should be interpreted as a classification rather than as a continuously precise measurement of liver function.
Class A covers 5 – 6 points, class B covers 7 – 9, and class C covers 10 – 15. A higher class generally indicates more severe hepatic dysfunction, but the score is only one part of a broader assessment. The Cleveland Clinic Child-Pugh overview explains the five factors, the 1 – 3 point structure, and how clinicians use the resulting class alongside other clinical information.