What Is the Child-Turcotte-Pugh Score (CTP)?

If you or someone you know has liver disease, you may know about the Child-Turcotte-Pugh score, also called the Child-Pugh grade. It rates how serious someone’s chronic liver disease is.

The score helps suggest how strong treatment should be. For example, depending on how your disease is classified, you may be given medications or you may have surgery.

How the Score Is Calculated

The Child-Pugh score is figured using five clinical measures of liver disease:

Total bilirubin: A yellowish compound found in bile and blood when hemoglobin breaks down

Albumin: The main protein in blood plasma, which the liver makes

Prothrombin time or INR: How long it takes your blood to clot

Ascites: Fluid in your abdominal cavity

Encephalopathy: How well your brain works with your liver disease

A score of 1, 2, or 3 is given to each measure, with 3 being the most serious.

For example, if you have no ascites, you get one point in that category. If you have mild ascites, you get two points. If you have moderate or severe ascites, you get three points.

What the Scores Mean

Once the scores are figured, they’re added up and your liver disease is put in one of three classes: A, B, or C.

Class A

  • Five to six points
  • Your disease is considered mild.
  • Surgery is safe for you.

Class B

  • Seven to nine points
  • Your disease is considered moderate.
  • You may have surgery.

Class C

  • 10-15 points
  • Your disease is considered severe.
  • You probably should not have surgery, except for a liver transplant.

There is some question about whether the Child-Pugh score is valid because some of the scoring is subjective. One doctor may rate ascites or how well your brain works differently than another, for example. But doctors say it is a good tool for measuring how well the liver works and how severe liver disease is. It can also help chart a treatment plan.

WebMD Medical Reference Reviewed by Dan Brennan, MD on June 12, 2020



Duquesne University Mylan School of Pharmacy: "What is the Child-Pugh scoring system and how does it relate to drug dosage?"

National Health Service: "What is the Child-Pugh Score?"

National Center for Biotechnology Information: "Bilirubin," "Albumin."

American Association for Clinical Chemistry, Lab Tests Online: "Albumin," "PT/INR."

American College of Gastroenterology: "Ascites: A Common Problem in People with Cirrhosis."

American Liver Foundation: "Hepatic Encephalopathy."

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