Five criteria are used for the Child-Pugh classification:2

  • Ascites
  • Brain damage (hepatic encephalopathy)
  • Concentration of albumin in the blood
  • Concentration of bilirubin in the blood
  • The time it takes blood to clot (international normalized ratio)

Ascites is a term used to describe the accumulation of fluid in the abdomen, resulting in an increase in the circumference of the abdomen. Ascites is usually determined by a scan (such as an ultrasound).3

Hepatic encephalopathy is a medical term for brain damage associated with liver disease. There are certain substances, such as ammonia, that would normally be removed by the liver. When the liver cannot do this, those substances accumulate in the blood and affect brain function. This results in confusion, changes in your ability to concentrate, personality changes and sleepiness.4

Albumin is a protein produced in the liver and is the most abundant protein in the blood. It regulates the distribution of fluids in the body and is also an important transport protein.5

Bilirubin is produced when the blood pigment hemoglobin is broken down, and would normally be broken down further by the liver. If the liver is not functioning properly, bilirubin can accumulate in the blood.6

The international normalized ratio is a marker for blood clotting and measures the time taken for blood to clot.7 The liver produces clotting factors, but when the liver is damaged, fewer of these are made,8 meaning that the blood will take longer to clot.

Your healthcare professional will assign points based on each of these 5 catagories:1

Parameter Score
1 2 3
Ascites None Mild Moderate or severe
Encephalopathy (grade) None 1-2 3-4
Bilrubin (micromole/L) <35 35-50 >50
Albumin (g/L) >35 28-35 <28
International normalized ratio <1.7 1.8-2.3 >2.3

The total score (between 5-15) corresponds with the Child-Pugh score ranging from Grade A (the lowest) to Grade C (the highest):1

Child-Pugh grade Child-Pugh score
A 5-6 Mild liver disease, liver is functioning well
B 7-9 Significant effect to functioning of liver
C 10-15 Severe liver disease

The sooner cirrhosis of the liver is recognized and treated, the better the chances of slowing down (or even preventing) progression of the disease. The early stage (Grade A) is associated with a 1 year survival rate of 84%, but this decreases as the disease progresses (by Grade C, this drops to 42%).1

Ärztin klärt ihre Patienten über den Child Pugh Score einer Leberzirrhose auf

The sooner cirrhosis of the liver is recognized and treated, the better the chances of slowing down (or even preventing) progression of the disease.


1. Whitehead S, et al. SPS NHS. What is the Child-Pugh Score. Available at: (Last accessed August 2020)

2. Durand F et al, Journal of Hepatology. 2005;42:S100-S107

3. BMJ Best Practice. Assessment of Ascites. Available at: (Last accessed August 2020)

4. Bleibel W et al, The Saudi Journal of Gastroenterology. 2012;18(5):301-309

5. Moman R et al, Stat Pearls. 2020. Available at: (Last accessed August 2020)

6. Murali A et al, Cleveland Clinic. 2017. Available at: (Last accessed August 2020)

7. University of Rochester Medical Center. International Normalized Ratio. Available at: (Last accessed August 2020)

8. Flores B et al, Journal of Translational Science. 2017;3(3):1-16

May 2021. GL-HEP-XIF-2000178

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