Gastrointestinal and Hepatobiliary · Chronic liver disease · Pugh modification, contemporary INR-based form

Child–Pugh Classification

Classifies the severity of chronic liver disease using five clinical and laboratory parameters. It is commonly used to describe hepatic functional reserve and support prognostic, procedural and treatment decisions.

Purpose

To stratify hepatic functional impairment in chronic liver disease, particularly cirrhosis, using bilirubin, albumin, coagulation, ascites and hepatic encephalopathy.

Parameter	1 point	2 points	3 points
Total bilirubin	<2 mg/dL	2–3 mg/dL	>3 mg/dL
Serum albumin	>3.5 g/dL	2.8–3.5 g/dL	<2.8 g/dL
INR	<1.7	1.7–2.3	>2.3
Ascites	None	Slight or diuretic-responsive	Moderate–severe or poorly controlled
Hepatic encephalopathy	None	Grade I–II	Grade III–IV
Total score and class	5–6: Class A	7–9: Class B	10–15: Class C

How to use it

Assign 1–3 points to each of the five parameters and add them to obtain a total score of 5–15.
Class A represents the least impaired hepatic function, Class B intermediate impairment and Class C the most severe impairment.
Ascites and encephalopathy introduce subjectivity and may change after treatment; interpret them in the stated clinical context.
The score describes hepatic functional reserve but does not replace MELD-based transplant-allocation assessment or procedure-specific risk evaluation.

Common mistake

Do not score prothrombin-time prolongation and INR as two separate parameters; they are alternative expressions of the same coagulation component.

Exam pearl

Remember the class ranges as A = 5–6, B = 7–9 and C = 10–15.

Viva questions

What is the Child–Pugh classification used for?: It grades hepatic functional impairment in chronic liver disease, particularly cirrhosis, and supports prognostic, procedural and treatment-risk assessment.
Which five parameters constitute the Child–Pugh score?: Total bilirubin, serum albumin, INR or prothrombin-time prolongation, ascites and hepatic encephalopathy.
How is each Child–Pugh parameter scored?: Each parameter receives 1, 2 or 3 points, with increasing points representing greater impairment. The five scores are added to produce a total between 5 and 15.
What total scores define Child–Pugh classes A, B and C?: Class A is 5–6 points, Class B is 7–9 points and Class C is 10–15 points.
Which Child–Pugh variables are subjective?: Ascites and hepatic encephalopathy are partly subjective and may change after diuretic, lactulose or other treatment.
Should both INR and prothrombin-time prolongation be scored?: No. They are alternative measures of the same coagulation component, so only one should contribute to the score.
What does Child–Pugh Class C indicate?: It indicates the most severe category of hepatic functional impairment, corresponding to a total score of 10–15.