Understanding the Child-Pugh Score: Assessing Liver Disease Severity


The Child-Pugh Score is an essential tool used by healthcare professionals to assess the severity and prognosis of chronic liver disease, particularly cirrhosis. This scoring system helps determine the life expectancy of patients, guide treatment decisions, and predict potential complications. Named after Dr. Charles Child and Dr. Jeremiah Pugh, the Child-Pugh Score provides a standardized method for evaluating liver function and the impact of liver disease on overall health.

Components of the Child-Pugh Score

The Child-Pugh Score is based on five clinical measures that reflect the liver’s functional capacity and the severity of liver disease. These measures include:

  • Bilirubin Levels: High bilirubin levels indicate liver dysfunction, as bilirubin is a byproduct of the normal breakdown of red blood cells. Elevated levels can cause jaundice, a yellowing of the skin and eyes.
  • Serum Albumin Levels: Albumin is a protein produced by the liver. Low levels of albumin suggest impaired liver function, as the liver is unable to synthesize adequate amounts of this essential protein.
  • Prothrombin Time (PT) or International Normalized Ratio (INR): These measures evaluate blood clotting. Liver disease can impair the production of clotting factors, leading to prolonged PT/INR and an increased risk of bleeding.
  • Ascites: The presence and severity of ascites, which is the accumulation of fluid in the abdominal cavity, indicate advanced liver disease and portal hypertension.
  • Hepatic Encephalopathy: This condition involves changes in mental state and cognitive function due to liver dysfunction and the accumulation of toxins in the brain. The severity of hepatic encephalopathy is graded based on clinical symptoms.

To calculate your score, you can use our Child-Pugh-Turcotte (CPT) Score Calculator.

Scoring and Classification

Each of the five components is assigned a score of 1 to 3, with higher scores indicating more severe liver dysfunction. The individual scores are then summed to obtain the total Child-Pugh Score, which ranges from 5 to 15. Based on the total score, patients are classified into one of three categories:

  • Class A (5-6 points): This class indicates well-compensated liver disease with the best prognosis. Patients in this category have the highest survival rates and typically experience fewer complications.
  • Class B (7-9 points): Class B represents significant functional compromise and an intermediate prognosis. Patients in this category are at a higher risk of developing complications and may require more intensive medical management.
  • Class C (10-15 points): This class signifies decompensated liver disease with the poorest prognosis. Patients in Class C often require liver transplantation and have a high risk of mortality and severe complications.

Clinical Applications

The Child-Pugh Score is widely used in clinical practice to guide decision-making for patients with chronic liver disease. It helps clinicians determine the need for interventions such as liver transplantation, the appropriateness of surgical procedures, and the selection of therapeutic options. For instance, patients with a high Child-Pugh Score may not be suitable candidates for certain surgeries due to the increased risk of complications and poor postoperative outcomes.

Additionally, the Child-Pugh Score is instrumental in assessing the prognosis of patients with liver disease. It provides valuable information about the expected survival rates and potential for complications, allowing healthcare providers to tailor treatment plans and offer appropriate supportive care.


While the Child-Pugh Score is a valuable tool, it is not without limitations. The scoring system relies on clinical and laboratory measures that can be influenced by factors other than liver function, such as nutrition and concurrent medical conditions. Moreover, the subjective nature of grading hepatic encephalopathy and ascites can lead to variability in scoring among different clinicians.

Despite these limitations, the Child-Pugh Score remains a cornerstone in the management of chronic liver disease. It provides a standardized approach to evaluating liver function and disease severity, helping to ensure consistent and informed clinical decision-making.