GI & Liver

Child-Pugh Score (CTP) Calculator

Grades the severity of cirrhosis into classes A, B and C from two clinical findings and three laboratory values.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Formula

Encephalopathy: none +1, grade 1–2 +2, grade 3–4 +3
Ascites: absent +1, slight +2, moderate +3
Bilirubin: under 2.0 mg/dL +1, 2.0–3.0 +2, over 3.0 +3
Albumin: over 3.5 g/dL +1, 2.8–3.5 +2, under 2.8 +3
Prothrombin time: INR under 1.7 (under 4 s prolonged) +1, 1.7–2.3 (4–6 s) +2, over 2.3 (over 6 s) +3
Class A 5–6, B 7–9, C 10–15

How it is used

• Mortality after abdominal surgery in cirrhosis: Class A 10%, B 30%, C 82% (Mansour 1997, 92 patients).
• Drug labels use Class A, B and C to mean mild, moderate and severe hepatic impairment when they give dose changes (FDA 2003).
• US transplant priority uses MELD 3.0, not Child-Pugh (OPTN 2023).
• Limits: ascites and encephalopathy grades are subjective; Pugh scored seconds of PT prolongation (the INR bands came later) and used bilirubin bands of 1–4, 4–10 and over 10 mg/dL in primary biliary cirrhosis (Pugh 1973).

Key points

• Warfarin, plasma and albumin infusions shift the INR and albumin without any change in liver function: note them before acting on the class.

Same formula as the app. Open it in the web app.

Related one-pagers

• GI Bleeding, Liver Failure and PancreatitisTransfuse at 7 g/dL, about 8 with cardiovascular disease (ACG 2021). Villanueva 2013 (921 patients, 7 vs 9 g/dL) found better 6-week survival (95% vs 91%) and less rebleeding (10% vs 16%) with restriction; the survival gain was in Child-Pugh A and B cirrhosis, and portal pressure rose only in the liberal arm.
• Pulmonary EmbolismShock or hypotension · Heparin now; bedside echo or CTPA, whichever is faster
• Subarachnoid HemorrhageDetect · Hourly exams; TCD MCA ≥120 cm/s, Lindegaard ≥3 (≥200 severe); CTA/CTP

Related calculators

• Bedside Index of Severity in Acute Pancreatitis (BISAP)
• Glasgow-Blatchford Bleeding Score (GBS)
• Model for End-Stage Liver Disease (MELD 3.0)

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.