How it's calculated
Five clinical and laboratory measures — bilirubin, albumin, INR, ascites, and hepatic encephalopathy — are each scored 1-3 points based on severity, for a total of 5-15 points, which maps to Child-Pugh Class A, B, or C.
Class and approximate survival
| Score | Class | Approximate survival |
|---|---|---|
| 5–6 | A | ~100% 1-year, ~85% 2-year |
| 7–9 | B | ~80% 1-year, ~60% 2-year |
| 10–15 | C | ~45% 1-year, ~35% 2-year |
Clinical use
- Child-Pugh class is widely used to estimate surgical risk in patients with cirrhosis undergoing non-transplant surgery, and to guide decisions around variceal bleeding prophylaxis and other cirrhosis-related interventions.
- MELD-Na has largely superseded Child-Pugh for liver transplant allocation priority (since it uses continuous lab values rather than broad bands) but Child-Pugh remains widely used for general prognosis and surgical risk discussions.
- The ascites and encephalopathy components are somewhat subjective (based on clinical assessment rather than a lab value), which is a recognised limitation compared to the more objective MELD-Na components.
- Child-Pugh Class C surgical patients face a very high perioperative mortality risk for major abdominal surgery — elective surgery is generally avoided in this group where possible.
Frequently asked questions
What is the Child-Pugh score used for?
It classifies the severity of liver disease in cirrhosis into Class A, B, or C, which is used to estimate prognosis and surgical risk, and to help guide decisions like variceal bleeding prophylaxis.
What's the difference between Child-Pugh and MELD-Na?
Child-Pugh uses five variables (two of which are semi-subjective clinical assessments — ascites and encephalopathy) grouped into broad severity bands, while MELD-Na uses only objective lab values (bilirubin, INR, creatinine, sodium) as a continuous score, and has become the primary tool for transplant allocation priority.
What does Child-Pugh Class C mean for surgery?
It indicates decompensated, severe liver disease with a very high perioperative mortality risk for major abdominal surgery — elective procedures are generally avoided in this group unless there's no reasonable alternative.
Are the ascites and encephalopathy scores based on tests?
No — unlike bilirubin, albumin, and INR, ascites and encephalopathy are scored based on clinical assessment of severity (none, mild/controlled, or moderate-severe/poorly controlled), which introduces an element of clinical judgement into the score.
References
- Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-649.
- Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85.
- European Association for the Study of the Liver (EASL). Clinical Practice Guidelines for the Management of Patients with Decompensated Cirrhosis.