Hepatology Risk score Moderate evidence Clinical review pending v1.0.0

Child-Pugh Score for Cirrhosis

How severe is this patient's cirrhosis?

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Total bilirubin

Serum albumin

INR

Ascites

None Slight (controlled with diuretics) Moderate to severe (despite diuretics)

Hepatic encephalopathy

None Grade 1–2 (or suppressed with medication) Grade 3–4 (or refractory)

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About this tool

Five-component score (bilirubin, albumin, INR, ascites, encephalopathy) grading cirrhosis into classes A–C.

Intended use

Patients with cirrhosis — prognosis, drug dosing and surgical risk.

Outcome

Cirrhosis severity / survival

Time horizon

1–2 years (classically)

Derivation population

Originally patients undergoing portosystemic shunt surgery / oesophageal transection.

Limitations

Ascites and encephalopathy grading are subjective.
Ceiling effects at each component.

Clinical problems

Liver disease

Evidence

Evidence level

Moderate evidence

Long-established and used in drug labelling; derived empirically in surgical cohorts. Methodology

Evidence summaries for this tool are awaiting independent clinical review. Statistics are shown only where they could be attributed to a specific publication.

References

Original publicationPugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-649. Find on PubMed (opens in a new tab)
Original publicationChild CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg 1964;1:1-85. Find on PubMed (opens in a new tab)

Version history

Version	Formula	Effective	Reviewer	Changes
v1.0.0	Pugh 1973	2026-10-03	—	Initial implementation with reference test vectors.

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Clinical decision support only. Interpret results in the context of the individual patient and current guidance; HumanPulse does not replace professional medical judgment.