Child-Pugh Score

What is the Child-Pugh score?

The Child-Pugh score is a way for healthcare providers to assess the severity of chronic liver disease, including cirrhosis of the liver. It helps them determine how well your liver is functioning, how close you are to liver failure and what treatment to recommend. The score also helps providers communicate information about your liver health in a consistent way.

The Child-Pugh score looks at the following five factors:

• Total bilirubin in your blood
• Serum albumin levels in your blood
• How quickly your blood clots (prothrombin time or INR)
• If there’s fluid in your abdomen (ascites)
• If liver disease is changing how your brain works (encephalopathy)

Each of the five factors receives a point value based on your results. Then, the total is added up. Finally, your provider assigns you a classification — class A, class B or class C.

It’s sometimes called the Child-Turcotte-Pugh (CTP) calculator. These numbers are important, but they aren’t the total picture of your health.

How do I prepare for a Child-Pugh score?

Getting your Child-Pugh score involves a physical exam, blood tests and imaging tests.

Your healthcare provider will ask for a blood sample so they can get results for:

• Bilirubin levels: A compound in bile that measures liver function
• Albumin levels: A protein your liver makes that helps transport nutrients in your blood
• Prothrombin time (PT) or INR: Your liver plays a role in how fast your blood clots

Your provider may use an abdominal ultrasound or a CT scan to measure fluid levels in your abdomen (ascites). Ascites means there’s excess fluid collecting in your belly. Cirrhosis is one of the main causes.

Testing for encephalopathy could involve a physical exam and/or a cognitive exam. Encephalopathy can happen when toxins build up in your blood due to liver damage.

You may need to avoid eating or drinking before these tests to get the most accurate results. Check with your healthcare provider so you know what kind of preparations are necessary.

These tests may happen at different places and on different days. This is OK. Once your provider has all the test results, they’ll use them to calculate your Child-Pugh score.

How is a Child-Pugh score calculated?

Healthcare providers calculate your score on five factors that relate to your liver health. For each factor, you can receive either one, two or three points. (One point is the least severe and three points is the most severe.)

Once each of the five factors has a score, your provider adds them up and gets an overall total. You’ll receive a total score between five and 15. That’s your Child-Pugh score.

This chart shows how a Child-Pugh score is calculated based on the results of each of the five factors:

Based on your total score, you’ll fall into three classifications:

1. Class A: Your liver is working normally. Your overall score is between five and six points.
2. Class B: There’s moderate liver damage. Your overall score is between seven and nine points.
3. Class C: There’s severe or advanced liver damage. Your score is between 10 and 15 points.

Here’s an example of test results with an overall score:

• Bilirubin is 3 mg/dL
• Albumin is 2.9 g/dL
• INR is 1
• Slight ascites
• No encephalopathy

This person’s Child-Pugh score would be 10, which is class C.

What does your Child-Pugh score tell you?

The score is a snapshot of how severe your liver disease is. It tells your provider how well your liver is working based on five factors. The Child-Pugh score can help your provider:

• Guide your treatment plan. It helps them decide if medications, surgery or a liver transplant are options for you and/or if they’d be successful.
• Assess risk. It helps them decide how risky or beneficial surgery would be to your overall health. It can help them predict your quality of life after surgery if the surgery were successful.
• Predicts survival rate. While survival rates are only estimates, your provider can use your score to predict if and how long you’d survive with or without treatment.

When should I call my healthcare provider?

Contact your healthcare provider if you have any questions about your score and how it was calculated. Talk to your provider if you have concerns about the test results or what comes next in your treatment plan.