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Calculate the Child-Pugh (Child-Turcotte-Pugh) score for cirrhosis: bilirubin, albumin, INR, ascites, and hepatic encephalopathy. Outputs total points, Class A/B/C, historical survival bands, and operative mortality teaching. Pair with liver labs and transplant teams for MELD/MELD-Na listing—not a substitute for specialist care.
Last updated: June 4, 2026
<2: 1 pt | 2–3: 2 pt | >3: 3 pt
>3.5: 1 pt | 2.8–3.5: 2 pt | <2.8: 3 pt
<1.7: 1 pt | 1.7–2.3: 2 pt | >2.3: 3 pt
Classification
Class A
Score: 5 points
Operative mortality (historical): ~10%
1-year survival
95–100%
2-year survival
85–90%
Interpretation
Well-compensated cirrhosis with relatively favorable prognosis in historical cohorts.
Score breakdown
Teaching notes
Education only. Transplant listing uses MELD/MELD-Na in many countries. Pair stroke risk with clinical judgment and bleeding assessment.
Class A demo
5 pts
Class A
Borderline labs → Class B
7 pts
Albumin 3.5 = 2 pts
Mild ascites, elevated INR
9 pts
Class B
Decompensated profile
15 pts
Class C
| Parameter | 1 pt | 2 pt | 3 pt |
|---|---|---|---|
| Total bilirubin (mg/dL) | < 2 | 2 – 3 | > 3 |
| Serum albumin (g/dL) | > 3.5 | 2.8 – 3.5 | < 2.8 |
| INR (or PT prolongation) | < 1.7 | 1.7 – 2.3 | > 2.3 |
| Ascites | None | Mild / controlled | Moderate–severe |
| Encephalopathy | None | Grade 1–2 | Grade 3–4 |
| Class | 1-year survival | 2-year survival | Surgery risk | Note |
|---|---|---|---|---|
| A (5–6 points) | 95–100% | 85–90% | ~10% operative mortality | Well-compensated; best surgical candidate among classes |
| B (7–9 points) | 80–85% | 55–60% | ~30% operative mortality | Transplant evaluation often discussed |
| C (10–15 points) | 45–50% | 35–40% | 70–80% operative mortality | Decompensated; urgent specialist care |
| Feature | Child-Pugh | MELD / MELD-Na |
|---|---|---|
| Parameters | 5 (labs + ascites + encephalopathy) | 3 labs: bilirubin, creatinine, INR |
| Subjectivity | Ascites and encephalopathy graded clinically | More objective laboratory inputs |
| Transplant allocation (U.S.) | Historical; largely replaced for listing | MELD/MELD-Na primary for priority |
| Best use today | Cirrhosis class, surgical risk teaching, prognosis bands | Short-term mortality, transplant queue |
Bilirubin: 1.2 mg/dL → 1 pt
Albumin: 3.8 g/dL → 1 pt
INR: 1.4 → 1 pt
Ascites: None → 1 pt
Encephalopathy: None → 1 pt
Total 5 → Class A (1-year survival teaching: 95–100%)
2 + 2 + 2 + 2 + 1 = 9 points → Class B
Significant functional compromise — closer transplant and complication monitoring.
Education only. Not for transplant decisions, procedure consent, or acute liver failure management without a hepatology team. Survival figures are historical averages.
For hepatology, surgery, and medical education
Suggested hashtags: #Hepatology #Cirrhosis #ChildPugh #MedEd