How is the Child-Pugh score calculated?

Five items each score 1 to 3 points: bilirubin (below 34, 34 to 50, above 50 µmol/L), albumin (above 35, 28 to 35, below 28 g/L), INR (below 1.7, 1.7 to 2.3, above 2.3), ascites (none, mild, moderate to severe) and encephalopathy (none, grade 1 to 2, grade 3 to 4). The total of 5 to 15 gives class A (5 to 6), B (7 to 9) or C (10 to 15).

What is the surgical risk with Child-Pugh class C?

In the classic series of abdominal operations in cirrhotic patients, mortality was about 10% in class A, about 30% in class B and about 75 to 80% in class C. Modern figures are lower, but class C remains a strong reason to avoid elective surgery.

Child-Pugh score calculator: class A, B or C

Creator: Dr. Mohammed Maree
Published: 2026-11-03
License: https://creativecommons.org/licenses/by-nc/4.0/

Written and clinically reviewed by Dr. Mohammed Maree, consultant minimally invasive and bariatric surgeon, Al-Makassed Hospital, Jerusalem, and Assistant Professor of Surgery, Al-Quds University. Last updated 3 November 2026.

Choose the values

Bilirubin

Albumin

INR

Ascites

Encephalopathy

The score

Item	1 point	2 points	3 points
Bilirubin, µmol/L (mg/dL)	Below 34 (below 2)	34–50 (2–3)	Above 50 (above 3)
Albumin, g/L	Above 35	28–35	Below 28
INR	Below 1.7	1.7–2.3	Above 2.3
Ascites	None	Mild	Moderate to severe
Encephalopathy	None	Grade 1–2	Grade 3–4

Class	Points	One-year survival	Mortality after abdominal surgery (older series)
A	5–6	About 100%	About 10%
B	7–9	About 80%	About 30%
C	10–15	About 45%	About 75–80%

A worked example

A man with alcohol-related cirrhosis and an umbilical hernia. Bilirubin 42 µmol/L (2), albumin 30 g/L (2), INR 1.5 (1), ascites controlled on spironolactone (2), no encephalopathy (1). 8 points, class B. Elective repair is reasonable only once the ascites is well controlled, because uncontrolled ascites is what makes these hernias recur and leak.

Child-Pugh or MELD?

Child-Pugh includes two subjective items (ascites and encephalopathy) and its bands are coarse. The MELD score uses only bilirubin, creatinine and INR (and sodium in MELD-Na), so it is more objective and is used to prioritise liver transplantation. Both predict surgical risk; many units use them together.

References

Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–9.
Mansour A, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997;122:730–5.
Teh SH, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 2007;132:1261–9.

Educational use

This calculator is a teaching aid. It does not replace clinical judgement, senior advice or your local guidelines.

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Child-Pugh score calculator