For healthcare professionals
Child-Pugh score calculator (class A, B or C)
The Child-Pugh score grades liver function in people with cirrhosis from five findings: encephalopathy, ascites, bilirubin, albumin and clotting. Each scores 1 to 3 points, and the total of 5 to 15 gives class A, B or C. The FDA uses these classes to group hepatic impairment as mild, moderate or severe in drug studies. This calculator is written for clinicians and is not a diagnosis.
Clinical findings and labs
US units. Use findings and labs from a stable period. Nothing you enter leaves this page.
What you will see
The Child-Pugh total from 5 to 15, the points for each finding, and class A, B or C.
Educational only, not medical advice. Not a diagnosis and not a dosing decision.
Source
US Food and Drug Administration, draft guidance on pharmacokinetics in patients with impaired hepatic function (September 2026), Table 1 and section IV.A.1. The guidance cites the original score by Pugh and colleagues, Br J Surg 1973. The tests check every cut point and class boundary in that table.
Validated in
The score was first used to grade patients with cirrhosis having surgery for bleeding oesophageal varices (Pugh 1973). The FDA recommends it to classify hepatic impairment in people with cirrhosis from chronic liver disease in drug studies. It is not meant for people without cirrhosis, and the FDA suggests other criteria for most people with cancer.
Limits
Ascites and encephalopathy are judged at the bedside, so two clinicians can score them differently, and diuretics change ascites. Anticoagulants or vitamin K deficiency raise the INR, Gilbert's syndrome raises bilirubin and IV fluids lower albumin, all without a change in liver function. Scoring during or soon after an acute event such as a bleed, infection or surgery can overstate the class. This tool gives no survival estimate.
Urgent symptoms
General safety advice (not part of the published score): a person with liver disease who vomits blood, passes black or bloody stools, becomes confused or very drowsy, or has a high fever with a swollen belly needs emergency care now. Call 911.
Child-Pugh points table
Each of the five findings scores 1, 2 or 3 points. The FDA table lists either prothrombin time (seconds above control) or INR for the clotting item (FDA 2026).
| Finding | 1 point | 2 points | 3 points |
|---|---|---|---|
| Encephalopathy grade | None | 1 or 2 | 3 or 4 |
| Ascites | Absent | Slight | Moderate |
| Total bilirubin (mg/dL) | Below 2 | 2 to 3 | Above 3 |
| Albumin (g/dL) | Above 3.5 | 2.8 to 3.5 | Below 2.8 |
| Prothrombin time (seconds prolonged) | Below 4 | 4 to 6 | Above 6 |
| or INR | Below 1.7 | 1.7 to 2.3 | Above 2.3 |
Source: Table 1 of the FDA guidance (FDA 2026).
Class A, B and C
A total of 5 to 6 points is class A, 7 to 9 is class B and 10 to 15 is class C. The FDA groups these as mild, moderate and severe hepatic impairment (FDA 2026). The FDA notes that other scores such as MELD have not been characterized well enough for drug handling to replace Child-Pugh in these studies, though MELD can help split patients within classes B and C (FDA 2026).
Where the score comes from
The FDA describes the system as first developed for patients with cirrhosis having portocaval shunt surgery (FDA 2026). Pugh and colleagues published the points version in 1973, in patients having surgery for bleeding oesophageal varices (Pugh 1973). Despite limits such as the subjective rating of ascites, the FDA calls it a useful marker of liver function and generally accepted to predict changes in how drugs are handled by the body (FDA 2026).
Scoring it well
The FDA asks drug studies to report the total and each of the five parts, and to say how ascites and encephalopathy were judged, for example whether ascites was rated on or off diuretics (FDA 2026). It also asks that changes in the parts come from the liver disease itself, since a raised INR, raised bilirubin or low albumin can have other causes, and it advises against scoring during or shortly after an acute event (FDA 2026). The same care makes the score more useful in the clinic.
Related tools
For transplant listing and short-term survival in end-stage liver disease, use the MELD score calculator, which gives MELD, MELD-Na and MELD 3.0 from lab values. To look for liver scarring before cirrhosis, the FIB-4 calculator uses age, AST, ALT and platelets, and the APRI calculator uses AST and platelets. For kidney function, which often guides drug dosing alongside liver function, see the eGFR calculator. For adults in hospital with pneumonia, see the CURB-65 calculator.
Sources
- US Food and Drug Administration, Center for Drug Evaluation and Research. Pharmacokinetics in Patients with Impaired Hepatic Function: Study Design, Data Analysis, and Impact on Dosage. Draft Guidance for Industry. September 2026. Section IV.A.1 and Table 1 (Child-Pugh classification). www.fda.gov/media/71311/download
- Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649. doi:10.1002/bjs.1800600817. PMID 4541913. doi.org/10.1002/bjs.1800600817
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.