Severity of cirrhosis and prognosis. Free to use.
Child-Pugh (Child-Pugh Score for Cirrhosis Mortality) is a validated clinical instrument used to assess severity of cirrhosis and prognosis. The instrument contains 5 items.
Source / attribution: Pugh RN et al., Br J Surg 1973
The instrument's primary construct — severity of cirrhosis and prognosis — is operationalized through a fixed set of items, each with a defined response format. This standardisation is what allows Child-Pugh scores to be compared meaningfully across clinicians, sites, and studies.
Like all screening or assessment instruments, Child-Pugh is a structured aid — not a diagnostic test in isolation. Results should be interpreted alongside history, examination, and clinical context. Where a score crosses an actionable threshold, the next step is typically a more detailed clinical evaluation rather than a definitive diagnosis.
Answer all 5 items below to see your Child-Pugh score and interpretation.
Each item is scored on a 3-point scale (1–3). Your score updates live as you answer.
All scoring runs in your browser. No data is sent anywhere — close the tab and the answers are gone.
Child-Pugh uses simple summation: each item's selected response is converted to a numeric value, and the values are added to produce a total score. Reverse-scored items are inverted before summation.
Scoring notes: Educational use only.
The cutoffs below are drawn from the published validation literature. Always interpret in clinical context.
| Score range | Band | Interpretation |
|---|---|---|
| 5–6 | Class A | Mild — best prognosis. |
| 7–9 | Class B | Moderate. |
| 10–15 | Class C | Severe — worst prognosis. |
This is an illustrative walkthrough, not a real patient. Follow the same four steps with your own answers — or use the live calculator at the top of this page.
Read each question and choose the response that best fits. Each response has a number next to it — that number is the item's score. The example below uses illustrative answers.
| # | Item | Example response | Score |
|---|---|---|---|
| 1 | Total bilirubin (mg/dL) | 2 – 3 | 2 |
| 2 | Albumin (g/dL) | > 3.5 | 1 |
| 3 | INR | 1.7 – 2.3 | 2 |
| 4 | Ascites | None | 1 |
| 5 | Encephalopathy | Grade I–II / controlled | 2 |
Add up all the item scores you noted in Step 1.
2 + 1 + 2 + 1 + 2 = 8
Find the row in the interpretation table whose range contains your total:
Total = 8 falls between 7 and 9 → Class B
Class B. 1-yr ~80%, 2-yr ~60%.
A score is one input alongside history and examination. Child-Pugh supports clinical judgment — it does not replace it.
If Child-Pugh doesn't fit your context, related instruments in gastroenterology include:
| Scale | Measures | Items | Time |
|---|---|---|---|
| MELD-Na | 3-month mortality in advanced liver disease; transplant prioritization | 5 | — |
| Glasgow-Blatchford | Pre-endoscopy risk in upper GI bleeding | 9 | — |
| ASA Physical Status | Pre-operative health status | 1 | — |
| Barthel Index | Functional independence in ADLs | 10 | — |
| BDI-II | Severity of depression | — | ≈ 5 minutes |
| CHA2DS2-VASc | Annual stroke risk in non-valvular atrial fibrillation | 8 | — |
| CURB-65 | 30-day mortality in community-acquired pneumonia | 5 | — |
| Glasgow Coma Scale | Level of consciousness after head injury | 3 | — |
Child-Pugh (Child-Pugh Score for Cirrhosis Mortality) is a validated instrument that assesses severity of cirrhosis and prognosis. It is designed for clinicians, medical students, evidence-synthesis researchers. The 5 items are summed to produce a total score.
Child-Pugh contains 5 items. Item scores are summed to produce the total. Scores run from 5 to 15, grouped into 3 interpretation bands from ‘Class A’ up to ‘Class C’.
On the Child-Pugh (total score 5–15), scores of 10–15 fall in the ‘Class C’ band — interpreted as: Severe — worst prognosis. The full ladder is: 5–6 — Class A: Mild — best prognosis.; 7–9 — Class B: Moderate.; 10–15 — Class C: Severe — worst prognosis. A higher score reflects a more severe presentation, and crossing a cutoff is a prompt to step up assessment or care — but these bands are screening thresholds, not diagnoses.
Scores of 5–6 fall in the ‘Class A’ band: Mild — best prognosis. A low score is reassuring but does not by itself rule out the underlying condition — if symptoms or clinical suspicion persist, reassess over time or use a complementary evaluation rather than relying on the number alone.
Yes — Child-Pugh is in the public domain and free for clinical, educational, and research use without permission. You can use this calculator and the scale itself freely; if you publish results or reproduce the scale, cite the original source paper.
Pugh RNH et al. Br J Surg. 1973;60(8):646-649. This is the original publication for the Child-Pugh — the reference to cite when reporting results.
No. Child-Pugh is a structured assessment aid, not a diagnostic test. Its proper role is clinical assessment of severity of cirrhosis and prognosis — it standardizes assessment and flags who needs closer evaluation, but the result must be weighed alongside history, examination, and clinical context. When a score conflicts with your clinical impression, clinical judgment takes precedence; treatment decisions should never rest on a screening score alone.
Child-Pugh is supported by the following peer-reviewed sources: