Free Child-Pugh Score Calculator

What Is the Child‑Pugh Score?

The Child‑Pugh classification (often called the Child‑Turcotte‑Pugh score) is a widely used hepatic function scoring system that evaluates the severity of liver cirrhosis. By combining three laboratory parameters (bilirubin, albumin, and INR) with two clinical observations (ascites and hepatic encephalopathy grade), the system produces a total score that places the patient into one of three severity classes—A, B, or C. This cirrhosis severity calculator gives clinicians immediate insight into prognosis, expected survival, and surgical risk. Although the MELD score has become the standard for transplant allocation, the Child‑Pugh classification remains an intuitive and easy‑to‑use tool for everyday clinical work, especially when a quick bedside assessment is needed.

How the Scoring System Works

The calculator simplifies the scoring process by letting the user enter or select the most recent values for five variables:

• Bilirubin – can be entered in mg/dL or μmol/L, eliminating manual unit conversion.
• Albumin – choose the correct range from the laboratory report.
• INR – select the appropriate INR range; advanced cirrhosis often elevates this value.
• Ascites – requires a subjective evaluation. Note whether ascites is absent, mild‑to‑moderate (responsive to diuretics), or severe (refractory).
• Hepatic encephalopathy grade – classify the patient using the West Haven criteria (described below).

Each variable contributes 1, 2, or 3 points to the total score. The sum is calculated as:

$$\text{Total points} = \text{Bilirubin points} + \text{Albumin points} + \text{INR points} + \text{Ascites points} + \text{Encephalopathy points}$$

The final total falls between 5 and 15, determining the Child‑Pugh class.

Hepatic Encephalopathy – West Haven Grading

Hepatic encephalopathy develops primarily from hyperammonemia and other metabolic disturbances caused by liver failure. The West Haven criteria provide a standardized grading system for the severity of neurological impairment:

Grade	Clinical Findings
I	Mild confusion, anxiety or euphoria, disrupted sleep rhythm, difficulty performing simple arithmetic
II	Personality changes, inappropriate behavior, disorientation to time, slurred speech, dyspraxia, asterixis
III	Gross disorientation, somnolence or semistupor, responsive only to strong stimuli, marked confusion
IV	Coma, no response to any stimuli

This encephalopathy stage is a direct component of the Child‑Pugh score and heavily influences the final classification.

Interpreting the Score

The total points correspond to three classes, each with a distinct prognosis and recommended management.

Points	Class	Description	1‑Year Survival	2‑Year Survival
5 – 6	A	Well‑compensated liver function	100%	85%
7 – 9	B	Significant functional compromise	80%	60%
10 – 15	C	Decompensated liver disease	45%	35%

Clinical Implications

• Class A patients are generally considered safe for elective surgery.
• Class B individuals should undergo pre‑operative optimization to improve their condition before any major procedure.
• Class C patients have a high perioperative risk, and major surgery is usually contraindicated.

Beyond cirrhosis assessment, the Child‑Pugh score is also integrated into the Barcelona Clinic Liver Cancer (BCLC) staging system, where it helps guide treatment decisions for patients with hepatocellular carcinoma.

Understanding Cirrhosis of the Liver

Cirrhosis refers to the pathological scarring of liver tissue. As functional hepatocytes are replaced by fibrotic scar tissue, the liver’s ability to perform its metabolic, synthetic, and detoxifying roles progressively declines. Cirrhosis is not a disease in itself but rather the common end‑stage outcome of chronic liver injury.

Most Frequent Causes

• Chronic viral hepatitis – predominantly hepatitis B and C.
• Alcoholic liver disease – due to long‑term excessive alcohol intake.
• Non‑alcoholic steatohepatitis (NASH) – fat accumulation and inflammation in the liver, frequently linked to obesity and metabolic syndrome.
• Primary biliary cholangitis and primary sclerosing cholangitis – autoimmune bile‑duct disorders.
• Autoimmune hepatitis – immune‑mediated attack on hepatocytes.
• Metabolic disorders – for example, Wilson disease and hereditary hemochromatosis.

Knowing the underlying cause is essential for targeted management, but the Child‑Pugh score remains a valuable tool for assessing the current functional severity regardless of etiology.