The Child-Pugh Score Calculator is a tool used to assess the severity of liver disease, specifically cirrhosis, and predict mortality risk. It evaluates five clinical parameters: bilirubin levels, serum albumin levels, prothrombin time, ascites presence, and hepatic encephalopathy. Each parameter is scored, and the total score helps classify patients into different categories (Class A, B, or C), guiding treatment decisions and patient management. This calculator is essential for healthcare providers in determining prognosis and planning appropriate care for patients with liver cirrhosis.
Patient Data Entry Guide
Step 1: Input Laboratory and Clinical Values
- Total Bilirubin: Enter value + unit (mg/dL or μmol/L).
- Example: 3.5 mg/dL or 60 μmol/L
- Serum Albumin: Enter value + unit (g/dL or g/L).
- Example: 2.5 g/dL or 25 g/L
- INR:
- Example: Enter value (e.g., 1.8).
- Ascites:
Absent(0 points).Mild(1 point: detectable by ultrasound only).Moderate/Severe(2 points: clinically apparent).
- Hepatic Encephalopathy:
Absent(0 points).Grade 1–2(1 point: mild confusion, asterixis).Grade 3–4(2 points: coma, severe disorientation).
Step 2: Input Symptoms
- Symptoms: Describe cirrhosis-related symptoms.
- Example: Jaundice, abdominal distension, confusion
Sample Diagnostic Report
Child-Pugh Score Calculation
- Input Data:
- Bilirubin: 3.5 mg/dL → 2 points (non-cholestatic).
- Albumin: 2.5 g/dL → 3 points.
- INR: 1.8 → 2 points.
- Ascites: Moderate → 2 points.
- Encephalopathy: Grade 2 → 1 point.
- Total Child-Pugh Score:2+3+2+2+1=10 Points2+3+2+2+1=10 Points
Interpretation
- Child-Pugh Class: C (10–15 Points).
- 1-Year Survival: ~45%.
- Transplant Urgency: High priority for evaluation.
Symptom Correlation
- Jaundice correlates with elevated bilirubin.
- Abdominal distension reflects ascites.
- Confusion aligns with hepatic encephalopathy.
Recommendations
- Transplant Evaluation: Immediate referral to a transplant center.
- Manage Complications:
- Ascites: Sodium restriction (<2 g/day), diuretics (spironolactone + furosemide).
- Encephalopathy: Lactulose, rifaximin.
- Monitor for Acute Events: Screen for variceal bleeding, SBP, hepatorenal syndrome.
Key Considerations
- Unit Conversions:
- Bilirubin: μmol/L → mg/dL (divide by 17.1).
- Albumin: g/L → g/dL (divide by 10).
- Limitations:
- Does not account for renal dysfunction (use MELD score for transplant listing).
- Subjective grading of ascites/encephalopathy.
Scoring Criteria:
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Bilirubin (mg/dL) | <2 (non-cholestatic) | 2–3 (non-cholestatic) | >3 (non-cholestatic) |
| <4 (cholestatic*) | 4–10 (cholestatic*) | >10 (cholestatic*) | |
| Albumin (g/dL) | >3.5 | 2.8–3.5 | <2.8 |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | Absent | Mild | Moderate/Severe |
| Encephalopathy | Absent | Grade 1–2 | Grade 3–4 |
| *Cholestatic diseases (e.g., PBC, PSC). |
Child-Pugh Class Mortality Table
| Class | Score | 1-Year Survival | 2-Year Survival |
|---|---|---|---|
| A | 5–6 | 95–100% | 85–90% |
| B | 7–9 | 80–85% | 60–70% |
| C | 10–15 | 45% | 35% |
Final Diagnosis: Combines Child-Pugh score, symptoms, and complications to prioritize interventions (e.g., transplant for Class C or diuretics for ascites in Class B).
✅ Formula Verification:
- Example: Bilirubin 3.5 mg/dL = 2 points, Albumin 2.5 g/dL = 3 points, INR 1.8 = 2 points, Ascites (moderate) = 2 points, Encephalopathy (Grade 2) = 1 point → Total 10 points → Class C.
Next Steps
- Calculate MELD-Na score for transplant prioritization.
- Perform upper endoscopy to screen for varices.
- Initiate HCC surveillance (ultrasound + AFP every 6 months).