Child-Pugh Score Calculator
Bilirubin, albumin, INR, ascites, encephalopathy — five items that grade cirrhosis A through C. Plus the panel most calculators skip: what each class means for anticoagulating the AF patient who also has liver disease.
Reviewed by Zaka Ahmed, MD Clinical reference · 4 min read
Child-Pugh Score
Score each item; total 5–15 maps to classes A (5–6), B (7–9), and C (10–15).
Score every item to see the class and what it changes.
Anticoagulation in this class (label positions)
Educational tool only. Anticoagulation in cirrhosis is a specialist, individualized decision — varices, platelet count, and renal function all move it — and label positions summarized here must be verified against current prescribing information. This tool does not replace clinical judgment or in-person evaluation.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
A 1970s surgical score that still runs hepatology
Child-Pugh began as an operative-risk estimate for portosystemic shunt surgery and survived because its five variables capture synthetic function (albumin, INR), excretion (bilirubin), and decompensation (ascites, encephalopathy) in one number. MELD has displaced it for transplant allocation, but drug labels — including every anticoagulant label — still speak Child-Pugh, which is why a stroke-prevention site hosts it.
AF, stroke prevention, and the cirrhotic patient
The pivotal DOAC trials excluded significant liver disease, so labels are built on pharmacology more than outcomes: class A permits standard dosing across agents, class B removes rivaroxaban and puts the rest on caution, class C removes DOACs entirely. Two clinical points deserve emphasis. First, cirrhosis is simultaneously hemorrhagic and prothrombotic — the elevated baseline INR does not anticoagulate the patient, and cardioembolic strokes happen in Child-Pugh C patients with AF. Second, HAS-BLED already counts hepatic dysfunction, so avoid double-counting the liver as a reason to withhold therapy that a formal risk conversation might support. In class B and beyond, make the decision jointly with hepatology, with varices screened and platelets known.
Frequently asked questions.
What are the Child-Pugh classes?
Class A: 5–6 points (well-compensated). Class B: 7–9 (significant compromise). Class C: 10–15 (decompensated). Historical one-year survival roughly 100%, 80%, and 45% respectively.
Child-Pugh or MELD?
MELD (creatinine, bilirubin, INR, sodium) is objective and drives transplant allocation; Child-Pugh persists in drug labeling and procedural risk discussion. They answer overlapping but different questions — drug dosing decisions reference Child-Pugh.
Can a Child-Pugh B patient with AF and prior stroke take any DOAC?
Apixaban is the agent most often chosen when anticoagulation is pursued in class B — with explicit caution, hepatology input, and varices addressed — while rivaroxaban is avoided per label. Evidence is observational; the honest framing to the patient is a shared decision under uncertainty.
References.
- Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. PubMed
- Steffel J, Collins R, Antz M, et al. 2021 EHRA practical guide on the use of NOACs in patients with atrial fibrillation. Europace. 2021;23(10):1612–1676. PubMed
- Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–156. PubMed