Child-Pugh Score

Chronic liver disease — severity class

Total bilirubin

< 2 mg/dL (< 34 µmol/L)

2–3 mg/dL (34–50 µmol/L)

> 3 mg/dL (> 50 µmol/L)

Serum albumin

> 3.5 g/dL

2.8–3.5 g/dL

< 2.8 g/dL

INR (or prothrombin time)

INR < 1.7 (PT < 4 s prolonged)

INR 1.7–2.3 (PT 4–6 s prolonged)

INR > 2.3 (PT > 6 s prolonged)

Ascites

None

Mild or diuretic-controlled

Moderate–severe or refractory

Hepatic encephalopathy

None

Grade 1–2 (or suppressed with medication)

Grade 3–4 (or refractory)

Evidence

Original publication

Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Introduced the modification of the Child–Turcotte grading (substituting bilirubin, albumin, and prothrombin time / ascites / encephalopathy) now known as the Child–Pugh score.

British Journal of Surgery, 1973

Open source

Validation

Christensen E, Schlichting P, Fauerholdt L, et al. Prognostic value of Child–Turcotte criteria in medically treated cirrhosis. Prospective cohort confirming the grading stratifies survival.

Hepatology, 1984

Open source

Last reviewed: 2026-09

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