The Child-Pugh score grades the severity of chronic liver disease — classically cirrhosis — using five variables: bilirubin, albumin, INR, ascites and encephalopathy. It stratifies patients into classes A, B and C, which track operative risk and prognosis.
High-yield: Class A = 5–6 points (well-compensated, 1-year survival ~100%),
Class B = 7–9 (significant compromise, ~80%), Class C = 10–15 (decompensated, ~45%). For
transplant allocation, MELD/MELD-Na has largely replaced Child-Pugh — but Child-Pugh remains the
standard for drug dosing in hepatic impairment and surgical risk assessment.
How to use it
Select the band that matches each of the five variables. Two points are subjective (ascites, encephalopathy) — grade them clinically: diuretic-responsive vs. refractory ascites, and encephalopathy grade (1–2: confusion/somnolence; 3–4: stupor/coma).
Don't miss: primary biliary cholangitis uses modified bilirubin cut-offs, and the
score was derived in a surgical shunt population (Child & Turcotte 1964, modified by Pugh 1973) —
it predicts prognosis, not transplant priority.
References
- Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964;1:1–85.
- Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–649.
Draft content — verify against the cited sources before relying on it.