Clinical & Hospital Pharmacy
Child-Pugh Score Calculator
Grades the severity of chronic liver disease (Class A, B or C) from three lab values and two clinical signs, with an optional MELD-Na score.
Child-Pugh class
Class A5 / 15 points
Class A — Well Compensated
Lab values
From the patient's liver function tests and coagulation screen.
Bands (mg/dL): < 2 → 1 pt, 2–3 → 2 pts, > 3 → 3 pts. 1 mg/dL = 17.1 µmol/L.
Bands (g/dL): > 3.5 → 1 pt, 2.8–3.5 → 2 pts, < 2.8 → 3 pts.
< 1.7 → 1 pt, 1.7–2.2 → 2 pts, > 2.2 → 3 pts. Normal is about 0.8–1.2.
Clinical findings
From examination and history.
Ascites
Hepatic encephalopathy (West Haven grade)
Try an example patient
MELD-Na score (optional)
Model for End-Stage Liver Disease with sodium — the UNOS 2016 refit used for transplant listing.
Prognosis & dosing
Hepatic drug dosing
Score breakdown
Points awarded for each finding, and where the total sits on the 5–15 scale.
Child-Pugh criteria (Pugh RN et al., Br J Surg 1973)
| Finding | 1 pt | 2 pts | 3 pts |
|---|---|---|---|
| Bilirubin (mg/dL) | < 2 | 2–3 | > 3 |
| Bilirubin, PBC/PSC (mg/dL) | < 4 | 4–10 | > 10 |
| Albumin (g/dL) | > 3.5 | 2.8–3.5 | < 2.8 |
| INR | < 1.7 | 1.7–2.2 | > 2.2 |
| Ascites | None | Mild | Moderate–severe |
| Encephalopathy | None | Grade 1–2 | Grade 3–4 |
Class A = 5–6 · Class B = 7–9 · Class C = 10–15
µmol/L bilirubin is divided by 17.1 and g/L albumin by 10, each rounded to one decimal, before the bands are applied.
MELD-Na (UNOS / OPTN 2016 refit)
MELD(i) = 9.57 × ln(Cr) + 3.78 × ln(Bili) + 11.2 × ln(INR) + 6.43
If MELD(i) > 11: MELD-Na = MELD(i) + 1.32 × (137 − Na) − [0.033 × MELD(i) × (137 − Na)]
Cr — serum creatinine (mg/dL, bounded 1.0–4.0); Bili — total bilirubin (mg/dL, minimum 1.0); INR minimum 1.0; Na — serum sodium (mEq/L, bounded 125–137). The result is capped at 6–40. 90-day mortality bands: ≤ 9 → 1.9%, 10–19 → 6.0%, 20–29 → 19.6%, 30–39 → 52.6%, ≥ 40 → 71.3%.
Reference: Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.
Common questions
Mild = Class A (5–6 points), moderate = Class B (7–9), severe = Class C (10–15). Always follow the specific drug's label, because the recommended dose change differs from drug to drug.
No. Switch the unit next to the field to µmol/L and the calculator divides by 17.1 for you. The breakdown shows the converted mg/dL value that was scored.
Only for cholestatic liver disease — primary biliary cholangitis or primary sclerosing cholangitis. Bilirubin rises early in these conditions, so the bands are higher (< 4, 4–10, > 10 mg/dL) to avoid over-scoring.
Child-Pugh is the standard for drug dosing and general prognosis. MELD-Na uses only objective lab values and is used to prioritise liver transplant candidates. They answer different questions, so many clinicians report both.
Ascites: none, mild (controlled with diuretics) or moderate–severe (tense or refractory). Encephalopathy uses the West Haven grades: grade 1–2 is mild confusion or asterixis, grade 3–4 is stupor or coma. Grade from the current clinical assessment.
Prepared by the PharmaWallah student team. Verify results with your textbook or instructor. Report an error · Editorial policy