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Child-Pugh Score: Child-Pugh Score: Cirrhosis Severity
Related Subjects: |Chronic liver disease |Cirrhosis |Alkaline phosphatase (ALP) |Liver Function Tests |Ascites Assessment and Management |Budd-Chiari syndrome |Autoimmune Hepatitis |Primary Biliary Cirrhosis |Primary Sclerosing Cholangitis |Wilson disease |Hereditary Haemochromatosis |Alpha-1 Antitrypsin (AAT) deficiency |Non alcoholic steatohepatitis (NASH) |Spontaneous Bacterial Peritonitis |Alcoholism and Alcoholic Liver Disease |Liver Transplantation |Child-Pugh score
The Child-Pugh score is used to assess the severity and prognosis of chronic liver disease, especially cirrhosis. It combines blood tests with clinical features of liver decompensation.
📋 Components
| Component | 1 point | 2 points | 3 points |
|---|---|---|---|
| Bilirubin | <34 micromol/L | 34–50 micromol/L | >50 micromol/L |
| Albumin | >35 g/L | 28–35 g/L | <28 g/L |
| Prothrombin time prolongation or INR | PT <4 sec prolonged
or INR <1.7 |
PT 4–6 sec prolonged
or INR 1.7–2.3 |
PT >6 sec prolonged
or INR >2.3 |
| Ascites | None | Mild / medically controlled | Moderate-severe / poorly controlled |
| Hepatic encephalopathy | None | Grade I–II | Grade III–IV |
📊 Interpretation
| Total score | Class | Severity |
|---|---|---|
| 5–6 | Child-Pugh A | Well-compensated disease |
| 7–9 | Child-Pugh B | Significant functional compromise |
| 10–15 | Child-Pugh C | Decompensated liver disease |
🧠 Clinical Use
- Estimates severity and prognosis in cirrhosis.
- Helps assess operative and anaesthetic risk in chronic liver disease.
- Used when considering liver transplant referral, TIPS suitability and some drug prescribing decisions.
- Higher scores indicate reduced hepatic synthetic function and greater risk of decompensation.
⚠️ Decompensation Features
- Ascites
- Jaundice
- Variceal bleeding
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
🚨 Red Flags in Cirrhosis
- Haematemesis or melaena
- New confusion or reduced consciousness
- Fever or abdominal pain in a patient with ascites
- Rapidly worsening jaundice
- Oliguria or rising creatinine
- Severe hyponatraemia
- Hypotension, sepsis or shock
🧠 Exam Pearls
- Child-Pugh uses bilirubin, albumin, INR/PT, ascites and encephalopathy.
- Scores range from 5 to 15.
- 5–6 = Child-Pugh A, 7–9 = B, 10–15 = C.
- Ascites and encephalopathy make the score partly clinical, not purely biochemical.
- Child-Pugh C indicates high-risk decompensated liver disease.
✅ Key message: Child-Pugh classifies cirrhosis severity using bilirubin, albumin, clotting, ascites and encephalopathy. A higher score means worse hepatic function and greater risk of complications.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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