Hepatic Function

Child-Pugh Score

Assess severity of liver cirrhosis and estimate surgical risk and prognosis.

When to use: Apply Child-Pugh score to patients with known cirrhosis to assess functional hepatic reserve, guide surgical risk stratification, and inform prognosis. Child-Pugh Class C contraindicates most elective surgery and signals need for MELD-Na scoring for transplant listing. The score also stratifies patients for pharmacokinetic dose adjustments of hepatically metabolised drugs (e.g., PPIs, NSAIDs, opioids).

Calculator

Total Bilirubin

Serum Albumin

INR (Prothrombin Time)

Ascites

Hepatic Encephalopathy

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Formula

Child-Pugh = Bilirubin(1-3) + Albumin(1-3) + INR(1-3) + Ascites(1-3) + Encephalopathy(1-3) 5–6 = Class A (good, 1yr survival 100%) | 7–9 = Class B | 10–15 = Class C (poor, 1yr survival 45%)

Key Points for NEET PG

Mnemonic: B-A-I-A-E — Bilirubin, Albumin, INR (or PT), Ascites, Encephalopathy — five parameters each scored 1–3.
Class A (5–6): operative mortality ~10%; Class B (7–9): ~30%; Class C (10–15): >82% — surgical risk thresholds frequently tested.
Child-Pugh Class C is a contraindication to elective surgery; preferred for transplant evaluation use MELD-Na.
Ascites and encephalopathy are the only clinical (non-lab) parameters — they are subjective but high-yield MCQ targets.
MELD-Na has largely replaced Child-Pugh for organ allocation in transplant programs; Child-Pugh still used for surgical risk assessment.

References

Child CG, Turcotte JG. Surgery and portal hypertension · Major Probl Clin Surg (1964)

Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices · Br J Surg (1973)

For educational purposes only. Not for clinical decision-making without professional oversight.