The Child-Pugh score is a scoring system to measure the severity of chronic liver disease inclusive of cirrhosis. The intention is to provide a system with which clinicians can objectively communicate about liver function.

The score is composed from several categories:

• total bilirubin, μmol/L (mg/dL)
  • <34: 1 point
  • 34-50: 2 points
  • >50: 3 points
• serum albumin, g/L
  • >35: 1 point
  • 28-35: 2 points
  • <28: 3 points
• INR
  • <1.7: 1 point
  • 1.7-2.3: 2 points
  • >2.3: 3 points
• presence of ascites
  • none: 1 point
  • mild: 2 points
  • moderate to severe: 3 points
• presence of hepatic encephalopathy
  • none: 1 point
  • grades I-II (or suppressed with medication): 2 points
  • grades III-IV (or refractory): 3 points

The point scores are then added up and classified as:

• class A: 5-6 points
• class B: 7-9 points
• class C: 10-15 points

If the patient has primary biliary cholangitis or sclerosing cholangitis then bilirubin is classified as ²:

• <68: 1 point
• 68–170: 2 points 
• >170: 3 points

Treatment and prognosis

Higher Child-Pugh scores indicate worsening liver function, and give the medical and surgical teams an idea of "liver comorbidity" and "liver reserve". This can be useful when planning interventions on the liver since liver failure is the main cause of death after liver resection ¹. Child-Pugh scores are used in the Barcelona clinic liver cancer (BCLC) staging system, for instance, to help guide therapy for hepatocellular carcinoma. 

Perioperative mortality:

• Child-Pugh A: 5%
  • may have up to 50% of liver resected
• Child-Pugh B: 10-15%
  • no more than 25% of liver resected
• Child-Pugh C: >25%
  • liver resection contraindicated

For grading liver dysfunction as an indication for liver transplantation, the MELD score is used.