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Child-Pugh Score

What Is the Child-Pugh Score?

The Child-Pugh score, also called the Child-Turcotte-Pugh score, rates the severity of long-term liver disease. It began in 1964 with two surgeons named Child and Turcotte, who designed it to predict the risk of death in people having a certain type of liver surgery. In 1973, a team led by a doctor named Pugh proposed changes. The score may now give doctors an idea of how patients will do after some other major operations.

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

How the Score Is Calculated

The Child-Pugh score uses five 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 your liver makes
  • Prothrombin time or INR, how long it takes your blood to clot
  • Ascites, fluid in your abdominal cavity
  • Encephalopathy, whether your brain is affected by your liver disease


Each measure gets one, two, or three points, with three 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.

MELD and PELD scores

Similar scores called MELD (model of end-stage liver disease) and PELD (pediatric end-stage liver disease) also measure severe illness. MELD is for anyone over age 12. PELD is for children younger than 12.

MELD and PELD involve bilirubin and INR as well as creatinine, which tells how well your kidneys are working.

Doctors use one of these two scores to decide which person gets a donor liver when one becomes available. The liver generally goes to the person on the waiting list who has the highest MELD or PELD score and is the same blood type as the donor.

Child-Pugh Score Results

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.

Some people question whether the Child-Pugh score is valid because some of the scoring is subjective. One doctor may rate ascites or encephalopathy differently than another, for example. But doctors say it’s 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 Brunilda Nazario, MD on August 04, 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?"

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American Liver Foundation: "Hepatic Encephalopathy."

Digestive Diseases and Sciences: “The Child-Turcotte Classification: From Gestalt to Sophisticated Statistics and Back.”

Medicine: “Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis.”

StatPearls: “Use of the Child Pugh Score in Liver Disease.”

University of Wisconsin Health: “MELD and PELD Scores.”

United Network for Organ Sharing: “Questions and Answers for Transplant Patients about MELD and PELD.”

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