How are Child-Pugh classes defined?

Class A (5–6 points): Well-compensated cirrhosis, 1-year survival ~100%. Class B (7–9 points): Significant functional compromise, 1-year survival ~80%. Class C (10–15 points): Decompensated cirrhosis, 1-year survival ~45%. Classes guide prognosis, surgical risk, and transplant evaluation.

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Child-Pugh-Score

Classify severity of liver cirrhosis and estimate prognosis. Score range: 5–15.

Eingaben

Total Bilirubin

Serum Albumin

INR

Ascites

Hepatic Encephalopathy

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Select all five criteria.

Class A (5–6)Well-compensated, 1-yr survival ~100%

Class B (7–9)Significant impairment, 1-yr survival ~80%

Class C (10–15)Decompensated, 1-yr survival ~45%

Disclaimer: Nur für Bildungszwecke. Kein Ersatz für klinische Beurteilung.

Wann verwenden

The Child-Pugh score is used to assess the prognosis of chronic liver disease/cirrhosis, guide surgical risk assessment, and determine the need for liver transplant evaluation.

Klinische Hinweise

MELD score has largely replaced Child-Pugh for transplant allocation in the US, but Child-Pugh remains useful for perioperative risk assessment and clinical staging.
Perioperative mortality: Class A ~10%, Class B ~30%, Class C ~80% for abdominal surgery.
Subjective components (ascites grade, encephalopathy grade) introduce inter-observer variability — a limitation addressed by MELD's objective lab-only approach.

References

Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. 1964:50-64.
Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.

Related tools

MELD / MELD-Na Score

Über dieses Tool

Was ist der Child-Pugh-Score?

The Child-Pugh score (also called the Child-Turcotte-Pugh or CTP score) is a clinical classification system used to assess the prognosis and severity of chronic liver disease, primarily cirrhosis. Originally developed by Child and Turcotte in 1964 for predicting surgical mortality in portal hypertension patients, it was modified by Pugh in 1973 to include INR instead of nutritional status. The score ranges from 5 to 15, incorporating five clinical and laboratory parameters: total bilirubin, serum albumin, INR (prothrombin time), ascites, and hepatic encephalopathy.

Scoring and Classification

Each parameter receives 1 to 3 points based on severity. The total score determines the Child-Pugh class: Class A (5–6 points) represents well-compensated cirrhosis with ~100% one-year survival; Class B (7–9 points) indicates significant functional compromise with ~80% one-year survival; Class C (10–15 points) represents decompensated cirrhosis with ~45% one-year survival. These survival estimates are approximations from the original studies and may be improved with modern management including TIPS and transplantation.

Clinical Applications and Limitations

The Child-Pugh score remains widely used for perioperative risk stratification, drug dosing adjustments in hepatic impairment (many drug labels reference Child-Pugh class), and general prognostic communication. However, its two subjective components (ascites grade and encephalopathy grade) introduce inter-observer variability. The MELD score, which uses only objective laboratory values (bilirubin, INR, creatinine), has replaced Child-Pugh for liver transplant allocation in the US. Despite this, Child-Pugh retains clinical utility for bedside assessment and surgical planning.

🔑 Klinische Hinweise

Child-Pugh C patients undergoing abdominal surgery have perioperative mortality of ~80% — surgery should be avoided if possible.
Many drug labels recommend dose reductions or avoidance in Child-Pugh B or C — always check before prescribing hepatically metabolized drugs.
MELD is preferred for transplant allocation; Child-Pugh is preferred for surgical risk and drug dosing guidance.
Ascites that is "controlled with diuretics" scores 2 points — only truly absent ascites scores 1 point.

Wichtige Referenzen

Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and Portal Hypertension. 1964:50-64.
Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.
Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42(Suppl 1):S100-S107.

Formel zuletzt überprüft: Februar 2026