{
  "slug": "child-pugh-score",
  "title": "Child-Pugh Score Calculator",
  "heading": "Child-Pugh Score for Cirrhosis Severity",
  "category": "fitness-health",
  "url": "https://www.revenuelab.fyi/toolbox/child-pugh-score",
  "summary": "Classify cirrhosis severity and estimate survival using five criteria.",
  "description": "Child-Pugh (Child-Turcotte-Pugh) classifies the severity of liver cirrhosis using bilirubin, albumin, INR (or prothrombin time), ascites, and hepatic encephalopathy, each scored 1-3 points for a total of 5-15. Class A (5-6 points) has the best prognosis, Class B (7-9) intermediate, and Class C (10-15) the worst, with associated one- and two-year survival estimates historically around 100%/85% for A, 80%/60% for B, and 45%/35% for C, though outcomes have improved with modern management. It has long been used to guide surgical risk assessment (cirrhotic patients undergoing abdominal surgery have substantially higher mortality with worsening class), variceal bleeding risk, and eligibility discussions for certain procedures. For liver transplant allocation specifically, the MELD score has largely superseded Child-Pugh because it uses more granular, continuous lab values rather than categorical point cutoffs, so use MELD for transplant listing decisions and Child-Pugh for general severity communication and surgical risk conversations. This tool is for education and workflow support only — not medical advice. Always verify results with a clinician and use clinical judgment alongside your institution's protocols.",
  "formula": "Sum of 5 criteria (1-3 points each): bilirubin, albumin, INR, ascites, encephalopathy. Class A: 5-6, B: 7-9, C: 10-15.",
  "dateModified": "2026-09-30",
  "run_url": "https://www.revenuelab.fyi/api/public/calc?tool=child-pugh-score",
  "inputs": [
    {
      "id": "bilirubin",
      "label": "Total bilirubin",
      "kind": "number",
      "hint": null,
      "default": 2.5,
      "unit": "mg/dL",
      "min": 0.1,
      "max": 40
    },
    {
      "id": "albumin",
      "label": "Albumin",
      "kind": "number",
      "hint": null,
      "default": 3,
      "unit": "g/dL",
      "min": 1,
      "max": 5.5
    },
    {
      "id": "inr",
      "label": "INR",
      "kind": "number",
      "hint": null,
      "default": 1.8,
      "unit": null,
      "min": 0.8,
      "max": 6
    },
    {
      "id": "ascites",
      "label": "Ascites",
      "kind": "select",
      "hint": null,
      "default": "mild",
      "options": [
        {
          "value": "none",
          "label": "None (1pt)"
        },
        {
          "value": "mild",
          "label": "Mild/controlled (2pt)"
        },
        {
          "value": "severe",
          "label": "Moderate-severe (3pt)"
        }
      ]
    },
    {
      "id": "encephalopathy",
      "label": "Hepatic encephalopathy",
      "kind": "select",
      "hint": null,
      "default": "none",
      "options": [
        {
          "value": "none",
          "label": "None (1pt)"
        },
        {
          "value": "grade12",
          "label": "Grade 1-2 (2pt)"
        },
        {
          "value": "grade34",
          "label": "Grade 3-4 (3pt)"
        }
      ]
    }
  ],
  "outputs": [
    {
      "id": "score",
      "label": "Child-Pugh score",
      "format": "number",
      "hint": null,
      "primary": true
    },
    {
      "id": "cls",
      "label": "Child-Pugh class",
      "format": "raw",
      "hint": null,
      "primary": false
    },
    {
      "id": "survival",
      "label": "Historical survival estimate",
      "format": "raw",
      "hint": null,
      "primary": false
    }
  ],
  "worked_example": {
    "inputs": [
      "Total bilirubin: 2.5 mg/dL",
      "Albumin: 3 g/dL",
      "INR: 1.8",
      "Ascites: Mild/controlled (2pt)",
      "Hepatic encephalopathy: None (1pt)"
    ],
    "outputs": [
      "Child-Pugh score: 9",
      "Child-Pugh class: B",
      "Historical survival estimate: ~80% (1yr) / ~60% (2yr)"
    ]
  },
  "how_to": {
    "title": "How to use this",
    "steps": [
      "Enter total bilirubin (mg/dL).",
      "Enter albumin (g/dL).",
      "Enter inr.",
      "Enter ascites.",
      "Enter hepatic encephalopathy.",
      "Read your child-pugh score on the right — it updates as you type.",
      "Hit Share to keep the scenario or send it to someone."
    ]
  },
  "scenarios": [
    {
      "name": "Conservative",
      "description": "Lower-end numbers — what if things land soft?",
      "values": {
        "bilirubin": 1.5,
        "albumin": 1.7999999999999998,
        "inr": 1.08,
        "ascites": "mild",
        "encephalopathy": "none"
      }
    },
    {
      "name": "Typical",
      "description": "Defaults — the most common real-world setup.",
      "values": {
        "bilirubin": 2.5,
        "albumin": 3,
        "inr": 1.8,
        "ascites": "mild",
        "encephalopathy": "none"
      }
    },
    {
      "name": "Ambitious",
      "description": "Higher-end numbers — what if things really pop?",
      "values": {
        "bilirubin": 4,
        "albumin": 4.800000000000001,
        "inr": 2.8800000000000003,
        "ascites": "mild",
        "encephalopathy": "none"
      }
    }
  ],
  "limitations": [
    "Population formulas describe averages; individual bodies vary, especially at the extremes of height, age, or muscle mass.",
    "Results do not account for medical conditions, medication, or pregnancy.",
    "Use this as a directional reference, not a diagnosis — talk to a clinician before acting on it."
  ],
  "faq": [
    {
      "q": "Why has MELD largely replaced Child-Pugh for transplant listing?",
      "a": "MELD uses continuous lab values (bilirubin, creatinine, INR, and now sodium) rather than categorical cutoffs, giving finer discrimination between patients of similar severity, which matters when ranking candidates on a transplant waitlist. Child-Pugh's 1-3 point buckets are simpler but less precise for that specific use."
    },
    {
      "q": "What is Child-Pugh still used for if not transplant listing?",
      "a": "It remains widely used for estimating surgical risk in cirrhotic patients (mortality rises steeply from Class A to C for abdominal surgery), general prognosis communication, and variceal bleeding risk stratification, where its simplicity and inclusion of clinical findings (ascites, encephalopathy) alongside labs is still valuable."
    },
    {
      "q": "Why does ascites and encephalopathy matter if they're subjective?",
      "a": "They capture clinically important decompensation that lab values alone miss — a patient can have relatively preserved labs but significant ascites or altered mentation reflecting more advanced disease. Their inclusion is part of why Child-Pugh has remained clinically relevant for decades despite being partly subjective."
    },
    {
      "q": "Can Child-Pugh class change over time?",
      "a": "Yes, and it should be reassessed at clinically relevant intervals or with any change in status, since cirrhosis severity and decompensation status change with treatment (diuretics for ascites, lactulose for encephalopathy, treating the underlying cause) or disease progression."
    }
  ],
  "related": [
    "https://www.revenuelab.fyi/toolbox/meld-score",
    "https://www.revenuelab.fyi/toolbox/has-bled-score",
    "https://www.revenuelab.fyi/toolbox/osmolar-gap"
  ],
  "license": "CC-BY-4.0",
  "citation": "RevenueLab — Child-Pugh Score Calculator (https://www.revenuelab.fyi/toolbox/child-pugh-score)"
}