Child-Pugh Score for Cirrhosis Mortality
Laboratory Values
Clinical Parameters
The Child-Pugh calculator is a clinical scoring system used to assess the severity of chronic liver disease, particularly cirrhosis. This Child-Pugh score calculator evaluates five key parameters: serum bilirubin, serum albumin, INR (prothrombin time), ascites, and hepatic encephalopathy. The Child-Pugh classification system has been the gold standard for liver disease staging since 1973, helping clinicians predict mortality and guide treatment decisions.
Healthcare professionals rely on the Child-Pugh calculator to stratify patients into three classes (A, B, and C), each representing different levels of liver dysfunction and prognosis. The Child-Pugh score ranges from 5 to 15 points, with higher scores indicating more severe liver disease and poorer outcomes. This Child-Pugh assessment tool is essential for liver transplant evaluation, surgical risk assessment, and long-term care planning.
Enter Laboratory Values
Input the patient's total bilirubin (mg/dL), serum albumin (g/dL), and INR values from recent laboratory results.
Assess Clinical Parameters
Select the appropriate ascites status (none, mild, or moderate-severe) and hepatic encephalopathy grade (none, grade 1-2, or grade 3-4).
Calculate the Score
Click "Calculate Child-Pugh Score" to generate the total score, classification, and survival predictions.
Interpret Results
Review the Child-Pugh class, survival rates, and clinical recommendations to guide patient management decisions.
Scoring Parameters (1-3 points each):
Bilirubin (mg/dL)
- • <2.0: 1 point
- • 2.0-3.0: 2 points
- • >3.0: 3 points
Albumin (g/dL)
- • >3.5: 1 point
- • 2.8-3.5: 2 points
- • <2.8: 3 points
INR
- • <1.7: 1 point
- • 1.7-2.3: 2 points
- • >2.3: 3 points
Ascites
- • None: 1 point
- • Mild: 2 points
- • Moderate-Severe: 3 points
Hepatic Encephalopathy
- • None: 1 point
- • Grade 1-2: 2 points
- • Grade 3-4: 3 points
Classification:
- Class A (5-6 points): Compensated cirrhosis, excellent prognosis
- Class B (7-9 points): Significantly impaired function, moderate prognosis
- Class C (10-15 points): Decompensated cirrhosis, poor prognosis
Case Study: 58-year-old Male with Alcoholic Cirrhosis
A 58-year-old male presents with a history of alcoholic liver disease. Recent laboratory results and clinical assessment reveal the following parameters for Child-Pugh score calculation.
Patient Parameters:
- Total Bilirubin: 2.8 mg/dL → 2 points
- Serum Albumin: 2.9 g/dL → 2 points
- INR: 1.9 → 2 points
- Ascites: Mild (controlled) → 2 points
- Encephalopathy: Grade 1 → 2 points
Calculation Result:
- Total Score: 10 points
- Classification: Child-Pugh Class C
- 1-year survival: 45%
- 2-year survival: 35%
- Recommendation: Urgent liver transplant evaluation
Liver Transplant Evaluation
Assess transplant candidacy and prioritization based on disease severity and predicted survival.
Surgical Risk Assessment
Evaluate perioperative risk for patients with cirrhosis undergoing surgical procedures.
Prognosis Communication
Provide patients and families with evidence-based survival predictions and treatment planning.
Clinical Trial Stratification
Stratify patients in research studies based on liver disease severity and expected outcomes.
Treatment Intensity Decisions
Guide decisions about aggressive interventions versus palliative care approaches.
Monitoring Disease Progression
Track changes in liver function over time and adjust management strategies accordingly.
Clinical Assessment Tips
- • Use the most recent laboratory values within 48-72 hours for accurate scoring
- • Ensure INR is not influenced by anticoagulant therapy when possible
- • Grade encephalopathy based on standardized criteria (West Haven scale)
- • Consider imaging studies to accurately assess ascites severity
Interpretation Guidelines
- • Child-Pugh Class A patients may be candidates for hepatic resection
- • Class B patients require careful evaluation for any surgical intervention
- • Class C patients should be prioritized for liver transplant evaluation
- • Consider MELD score for more precise transplant allocation
Limitations to Consider
- • Subjective assessment of ascites and encephalopathy may vary between clinicians
- • MELD score may be more accurate for short-term mortality prediction
- • Score may not reflect acute decompensation or rapid clinical changes
- • Consider additional factors like renal function and nutritional status
| Aspect | Child-Pugh Score | MELD Score |
|---|---|---|
| Primary Use | Long-term prognosis, surgical risk | Short-term mortality, transplant allocation |
| Parameters | 5 parameters (3 lab + 2 clinical) | 3 laboratory parameters only |
| Objectivity | Partially subjective | Completely objective |
| Best For | Comprehensive liver disease staging, surgical planning | Transplant listing, acute assessment |
Recommendation: Use Child-Pugh for comprehensive liver disease staging and long-term management decisions. Use MELD score for transplant allocation and short-term mortality prediction. Both scores complement each other in clinical practice.
What is a normal Child-Pugh score?
The Child-Pugh score ranges from 5-15 points. A score of 5-6 points (Class A) represents compensated cirrhosis with the best prognosis. Scores of 7-9 (Class B) and 10-15 (Class C) indicate progressively worse liver function and prognosis.
How accurate is the Child-Pugh calculator for predicting survival?
The Child-Pugh score has been validated in multiple studies with good predictive accuracy for long-term survival. However, individual patient outcomes may vary based on additional factors like age, comorbidities, and response to treatment.
Can the Child-Pugh score change over time?
Yes, the Child-Pugh score can improve or worsen based on disease progression, treatment response, or development of complications. Regular reassessment is important for ongoing patient management.
When should I use Child-Pugh vs MELD score?
Use Child-Pugh for comprehensive liver disease staging, surgical risk assessment, and long-term prognosis. Use MELD score for liver transplant allocation and short-term (3-month) mortality prediction.
What are the limitations of the Child-Pugh calculator?
The main limitations include subjective assessment of ascites and encephalopathy, potential inter-observer variability, and the categorical rather than continuous scoring system. MELD score addresses some of these limitations with objective laboratory values only.
Survival Statistics
- • Class A: 100% 1-year, 85% 2-year survival
- • Class B: 81% 1-year, 57% 2-year survival
- • Class C: 45% 1-year, 35% 2-year survival
Clinical Impact
- • Used in >90% of liver transplant centers globally
- • Validated in >50,000 patients across multiple studies
- • Standard assessment tool for 50+ years
Surgical Risk
- • Class A: 10% operative mortality
- • Class B: 30% operative mortality
- • Class C: 76-82% operative mortality
Global Usage
- • Referenced in >10,000 medical publications
- • Standard in hepatology practice worldwide
- • Included in major clinical guidelines