Child-Pugh Score

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In medicine, the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation.


The score employs five clinical measures of liver disease. Each measure is scored 1-3, with 3 indicating most severe derangement.

Measure 1 point 2 points 3 points units
Bilirubin (total) <34 (<2) 34-50 (2-3) >50 (>3) μmol/l (mg/dl)
Serum albumin >35 28-35 <28 g/l
INR <1.7 1.71-2.20 > 2.20 no unit
Ascites None Mild (or suppressed with medication) Refractory no unit
Hepatic encephalopathy None Grade I-II (or suppressed with medication) Grade III-IV (or refractory) no unit

It should be noted that different textbooks and publications use different measures. Some older reference works substitute PT prolongation for INR.

In primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), the bilirubin references are changed to reflect the fact that these diseases feature high conjugated bilirubin levels. The upper limit for 1 point is 68 μmol/l (4 mg/dl) and the upper limit for 2 points is 170 μmol/l (10 mg/dl).


Chronic liver disease is classified into Child-Pugh class A to C, employing the added score from above.

Points Class One year survival Two year survival
5-6 A 100% 85%
7-9 B 81% 57%
10-15 C 45% 35%

Other scoring systems

The MELD Score may [1] or may not[2][3] perform better than the Child-Pugh Score.


Dr C.G. Child and Dr J.G. Turcotte of the University of Michigan first proposed the scoring system in 1964.[4] It was modified by Pugh in 1972 [5]. He replaced Child's criterion of nutritional status with the prothrombin time or INR, and thus eliminated the most subjective part of the score.


  1. Farnsworth N, Fagan SP, Berger DH, Awad SS (November 2004). "Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients". Am. J. Surg. 188 (5): 580–3. DOI:10.1016/j.amjsurg.2004.07.034. PMID 15546574. Research Blogging.
  2. Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD (August 2004). "Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores". Clin. Gastroenterol. Hepatol. 2 (8): 719–23. PMID 15290666[e]
  3. Angermayr B, Cejna M, Karnel F, et al (June 2003). "Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt". Gut 52 (6): 879–85. PMID 12740346. PMC 1773665[e]
  4. Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
  5. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). "Transection of the oesophagus for bleeding oesophageal varices". The British journal of surgery 60 (8): 646–9. DOI:10.1002/bjs.1800600817. PMID 4541913. Research Blogging.

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