Child-Pugh Classification
Classify hepatic cirrhosis severity and estimate prognosis using Child-Pugh score.
Important Medical Disclaimer
This calculator is an educational and clinical decision support tool. Results DO NOT replace professional medical evaluation, laboratory tests, or clinical judgment. Always consult a qualified healthcare professional for diagnosis, treatment, and clinical decisions. Calculations are based on scientifically validated formulas but may not be applicable to all patients.
Calculate Child-Pugh
What is Child-Pugh?
Child-Pugh classification assesses cirrhosis severity through 5 parameters (encephalopathy, ascites, bilirubin, albumin, INR), each scored 1-3. Total 5-15 points. Class A (5-6): compensated, good prognosis. Class B (7-9): significant decompensation. Class C (10-15): severe decompensated, high risk. Originally developed in 1964 (Child-Turcotte), modified in 1973 (Pugh).
When to use Child-Pugh?
Use to stratify cirrhosis severity, estimate prognosis, decide on liver transplant (Child B/C are indications), assess surgical risk (surgical mortality: A=10%, B=30%, C=80%), adjust medication doses. Useful in hepatitis C, alcoholic, NASH. MELD more used for transplant list in USA, but Child-Pugh still valid.
Limitations and Considerations
Encephalopathy and ascites are subjective. Doesn't consider renal function (MELD does). Bilirubin may be elevated in cholestasis without cirrhosis. Albumin may be low from malnutrition or nephrotic syndrome. INR may be high from anticoagulants or vitamin K deficiency. Child-Pugh not linear (change from A to B not equivalent to B to C). Use MELD for transplant, Child-Pugh for general stratification.
Frequently Asked Questions about Child-Pugh
What's the difference between Child-Pugh and MELD?
Child-Pugh: 5 variables (2 clinical, 3 lab), classes A/B/C, subjective (encephalopathy/ascites). MELD: 3 variables (bilirubin, creatinine, INR), continuous score 6-40, objective, considers renal function. MELD used for transplant list in USA/Brazil (prioritizes sicker). Child-Pugh for general stratification and surgical risk.
Does Child-Pugh B or C always need transplant?
Not necessarily. Child B may be transplant candidate if complications present (recurrent encephalopathy, refractory ascites, variceal hemorrhage). Child C usually transplant indication, but may have contraindications (extrahepatic cancer, sepsis, active alcoholism). Evaluate case-by-case with hepatologist.
How to interpret surgical mortality?
Elective abdominal surgery: Child A ~10% mortality, B ~30%, C ~80%. Avoid elective surgeries in Child C (prohibitive risk). Child B requires intensive preparation (correct coagulopathy, ascites, malnutrition). Minor surgeries (hernia repairs) have lower but still elevated risk in Child C.
Does Child-Pugh work for acute liver disease?
No. Child-Pugh was developed for chronic cirrhosis. In severe/fulminant acute hepatitis, use King's College Criteria or MELD. Child-Pugh underestimates severity in acute deteriorations (high INR may be transient). Also don't apply in cholestasis without cirrhosis or acute-on-chronic liver failure (use CLIF-SOFA).