Child-Pugh score calculator and the 1973 table
For healthcare professionals and students. Check results against your local protocols and clinical judgement; this tool does not give medical advice.
This Child-Pugh score calculator grades the severity of chronic liver disease, usually cirrhosis, from five findings: serum bilirubin, serum albumin, clotting (INR or prothrombin time), ascites and hepatic encephalopathy. Each scores 1 to 3 points; the total of 5 to 15 gives Class A, B or C. You type the laboratory values in the units your report uses — mg/dL or µmol/L for bilirubin, g/dL or g/L for albumin — and the tool shows which band each value falls in.
The score is still used in hepatology, surgery and drug labelling to describe hepatic impairment. It is calculated entirely in your browser; nothing is sent anywhere.
How to use the Child-Pugh Score Calculator
- Enter the total bilirubin and choose mg/dL or µmol/L.
- Enter the serum albumin in g/dL or g/L.
- Enter the INR, or switch to PT seconds over control to use the original measure.
- Tick Cholestatic disease for primary biliary cholangitis or primary sclerosing cholangitis if your protocol uses the modified bilirubin bands.
- Choose the grade of ascites and hepatic encephalopathy, then read the points, class and notes.
Child-Pugh Score Calculator features
Pugh’s original bands
Bilirubin, albumin and prothrombin time bands from the 1973 paper, with each value’s band shown.
INR or PT
INR bands of under 1.7, 1.7–2.3 and over 2.3, or the original seconds of prolongation.
SI units done exactly
µmol/L bilirubin is converted with 17.1 and the tool tells you when a rounded 34/50 µmol/L chart would score differently.
Cholestatic option
The modified bilirubin bands (under 4, 4–10, over 10 mg/dL) for PBC and PSC.
Copyable summary
Points for each criterion and the class in one line for the notes.
Child-Pugh criteria
The score adapts the classification of Child and Turcotte (1964), which used nutritional status. Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC and Williams R, “Transection of the oesophagus for bleeding oesophageal varices”, Br J Surg 1973;60(8):646–649, replaced nutrition with prothrombin time and scored each feature 1, 2 or 3; the abstract reports that this simple scoring system was of value in predicting the outcome of surgery. Where the published bands overlap — bilirubin “1–2” and “2–3” mg/dL, prothrombin time “1–4” and “4–6” seconds — a value exactly on the shared boundary gets the higher point, as in most modern tables (under 2, 2–3, over 3).
| Measure | 1 point | 2 points | 3 points |
|---|---|---|---|
| Bilirubin, mg/dL (µmol/L) | under 2 (under 34) | 2–3 (34–50) | over 3 (over 50) |
| Albumin, g/dL (g/L) | over 3.5 (over 35) | 2.8–3.5 (28–35) | under 2.8 (under 28) |
| Prothrombin time, seconds over control | under 4 | 4–6 | over 6 |
| INR (later convention) | under 1.7 | 1.7–2.3 | over 2.3 |
| Ascites | None | Slight | Moderate |
| Hepatic encephalopathy | None | Grade 1–2 | Grade 3–4 |
Classes and what they mean
Pugh grouped the totals into grade A (5–6 points), B (7–9) and C (10–15). In everyday use the classes are a shorthand for compensated (A) through decompensated (C) liver disease, but the score was derived to predict surgical outcome in a small series and has known weaknesses: ascites and encephalopathy are graded subjectively, albumin can be changed by infusion, and the INR varies between laboratories and with anticoagulants. The MELD score calculator uses objective laboratory values instead and is used for transplant listing.
Survival figures by class appear in many references without a primary source; this page does not quote them.
Units, INR and cholestatic disease
Pugh’s table is in mg/100 mL (mg/dL) for bilirubin and g/100 mL (g/dL) for albumin. Bilirubin has a molar mass of 584.66 g/mol, so 1 mg/dL = 17.1 µmol/L and the 2 and 3 mg/dL cut-offs are 34.2 and 51.3 µmol/L; UK and Canadian charts usually round these to 34 and 50. Albumin converts exactly: 3.5 g/dL = 35 g/L, 2.8 g/dL = 28 g/L.
The INR bands are a later substitution for seconds of prolongation and are not in the 1973 paper. Many references also reproduce modified bilirubin bands (under 4, 4–10 and over 10 mg/dL; 68 and 170 µmol/L) for cholestatic diseases, where bilirubin rises early; we could not confirm where they were first published, so use them only if your protocol does. Worked example (self-test): bilirubin 2.4 mg/dL, albumin 3.1 g/dL, INR 1.5, slight ascites, no encephalopathy gives 2 + 2 + 1 + 2 + 1 = 8, Class B.
Child-Pugh Score Calculator FAQ
What is the Child-Pugh score formula?
There is no equation — it is a points table. Bilirubin, albumin, INR or prothrombin time, ascites and encephalopathy each score 1–3, and the total (5–15) gives Class A (5–6), B (7–9) or C (10–15). The Child-Pugh score calculator above applies the bands.
How do I use the Child-Pugh score in the UK or Canada with µmol/L and g/L?
Choose µmol/L for bilirubin and g/L for albumin. The tool converts exactly (17.1 and 10) and flags the narrow range where a chart rounded to 34/50 µmol/L would give a different point.
Should I use INR or prothrombin time?
Use one, not both. The original table used seconds over control; most laboratories now report INR, and the INR bands are a widely used later convention.
Is Child-Pugh the same as MELD?
No. MELD is calculated from bilirubin, INR, creatinine and, in newer versions, sodium and albumin, and was built to predict short-term mortality. Child-Pugh includes clinical findings and gives a class.
Does anticoagulation affect the score?
Yes. Warfarin and similar drugs raise the INR independent of liver function, so the clotting criterion is unreliable in an anticoagulated patient.
Why do different calculators give different classes for the same patient?
Boundary handling, rounded SI cut-offs, INR versus PT and the grading of ascites all vary. This page states each choice it makes.