Child-Pugh Calculator

The Child-Pugh score, also called the Child-Turcotte-Pugh score, classifies the severity of chronic liver disease and cirrhosis. It combines three laboratory measurements with two clinical assessments. Total bilirubin reflects the liver's ability to process and excrete bile pigments, albumin reflects hepatic protein synthesis and nutritional or inflammatory influences, and INR reflects clotting-factor synthesis. Ascites and hepatic encephalopathy represent important manifestations of decompensation. Each parameter receives one, two, or three points. In the commonly used noncholestatic thresholds, bilirubin below 2 mg/dL receives one point, 2 through 3 receives two, and above 3 receives three. Albumin above 3.5 g/dL receives one point, 2.8 through 3.5 receives two, and below 2.8 receives three. INR below 1.7 receives one point, 1.7 through 2.3 receives two, and above 2.3 receives three. No ascites or encephalopathy receives one point; controlled or low-grade findings receive two; refractory ascites or grade 3 to 4 encephalopathy receives three. The five values sum to a score from 5 through 15. Scores of 5 or 6 are Class A, scores of 7 through 9 are Class B, and scores from 10 through 15 are Class C. Higher classes generally represent more impaired hepatic function and have historically been associated with poorer surgical tolerance and survival. The system is used in prognosis, treatment planning, medication considerations, and descriptions of study populations. The score has limitations. Ascites and encephalopathy grading involve clinical judgment and may change with treatment. Albumin can be affected by nutrition, kidney loss, inflammation, or replacement. INR can be altered by anticoagulants and does not fully describe bleeding or clotting balance in cirrhosis. Some cholestatic diseases use different bilirubin thresholds, so the appropriate disease-specific method should be confirmed. The Model for End-Stage Liver Disease is often used for transplant allocation and may be preferred for particular decisions. Values should be measured in compatible units and close enough in time to represent the same clinical state. This calculator uses bilirubin in mg/dL and albumin in g/dL. It is an educational implementation of common thresholds, not a diagnosis or transplant assessment. Worsening confusion, vomiting blood, black stools, rapidly increasing abdominal swelling, jaundice with illness, fever, severe weakness, or reduced consciousness can signal an urgent complication and requires prompt medical care.