Clinical Overview: The Child-Pugh Score
The Child-Pugh score (sometimes called the Child-Turcotte-Pugh score) is a classic prognostic system used in hepatology and gastroenterology to assess the prognosis of chronic liver disease, primarily cirrhosis. Originally designed in 1964 to predict mortality during liver surgery, it is now widely used to determine the required strength of medical treatments and the necessity of a liver transplant.
While the MELD score has largely replaced Child-Pugh for actual transplant waitlist allocation (because MELD uses only objective lab data), Child-Pugh remains heavily utilized in everyday clinical practice for medication dosing and general prognosis.
The Five Variables
The score combines two subjective clinical assessments with three objective laboratory measurements:
- Encephalopathy (Subjective): The buildup of ammonia affects the brain, causing confusion or coma. Graded from none to severe.
- Ascites (Subjective): The accumulation of fluid in the abdomen due to portal hypertension. Graded from absent to severe/refractory.
- Bilirubin (Objective): Measures the liver's ability to excrete bile.
- Albumin (Objective): Measures the liver's synthetic function (its ability to build proteins).
- INR/Prothrombin Time (Objective): Measures the liver's ability to synthesize blood-clotting factors.
Formula Breakdown
Each of the five variables is assigned 1, 2, or 3 points:
Child-Pugh Score = Encephalopathy + Ascites + Bilirubin + Albumin + PT/INR
The total points classify the patient into one of three severity classes:
- Class A (5-6 points): Well-compensated disease. 1-year survival rate is nearly 100%.
- Class B (7-9 points): Significant functional compromise. 1-year survival rate drops to ~80%.
- Class C (10-15 points): Decompensated disease. 1-year survival rate plummets to ~45%.
Disclaimer: This calculator provides educational prognostic stratification. Liver disease requires rigorous medical management by a board-certified hepatologist or gastroenterologist.