AI Summary The Child-Pugh score sorts people with cirrhosis into class A, B, or C to show how advanced liver disease is. Doctors calculate it from blood tests and exam findings, with no biopsy or scan needed. It does not diagnose cirrhosis. Class A is least severe and class C is most severe. Doctors use it to plan surgery, treat variceal bleeding, guide liver cancer and hepatitis C care, and often read it alongside MELD.
Source: www.liverdirectory.com
The Child-Pugh score, also called the Child-Turcotte-Pugh (CTP) score, groups people with cirrhosis into class A, B, or C. Cirrhosis is permanent scarring of the liver. A higher class means more advanced liver disease.
Your care team builds the score from blood tests and findings from your exam. No biopsy or scan is needed to calculate it. Doctors use the class to judge risk, plan treatment, and decide what to do next.
This page explains what the classes mean, when doctors use the score, how it differs from MELD, and what to ask your care team.
Liver Health AI Assistant
Ask Aimy
Aimy answers from LiverDirectory’s reviewed health information — helping patients make sense of liver-health terms, prepare for specialist visits, and explore what to look up next.
CIRRHOSIS SEVERITY SCORING
The Child-Pugh score is a way to describe how severe cirrhosis is. It turns several results into one score, and that score places you in class A, B, or C. Doctors also call it the Child-Turcotte-Pugh score.
The score reflects how well your liver still works. Liver function shows up in blood tests. Albumin, a protein your liver makes, drops when the liver is damaged. Bilirubin, a yellow pigment, can build up and cause jaundice. The INR, a measure of blood clotting, rises when the liver makes fewer clotting proteins.
The score also takes into account complications of advanced cirrhosis, such as fluid in the abdomen (ascites) and confusion from hepatic encephalopathy.
Guidelines divide cirrhosis into two broad stages. In compensated cirrhosis, there are no obvious complications yet. In decompensated cirrhosis, complications such as ascites, bleeding from enlarged veins (varices), hepatic encephalopathy, or jaundice have appeared. The Child-Pugh class gives your care team a shared language for where you fall along that path.
The score does not diagnose cirrhosis. Doctors confirm cirrhosis with imaging, stiffness tests such as FibroScan, or a liver biopsy. The Child-Pugh score comes after, to describe severity.
Your care team interprets your score. This page is for education, not diagnosis.
CIRRHOSIS CARE DECISIONS
Your care team may check your Child-Pugh class at several points in your care.
Doctors may use the score, often with MELD, to estimate the risk of surgery in people with cirrhosis. A 2025 American College of Gastroenterology (ACG) guideline lists Child-Pugh among the recommended tools. It also says other health problems, such as heart failure, lung disease, cancer, and frailty, add to surgical risk.
AASLD guidance says people with class C cirrhosis, or class B with active bleeding, are at high risk when standard treatment for bleeding varices does not work. For them, doctors may consider an early [TIPS procedure](/liver-therapies/interventional-procedures/portal-hypertension-procedures/transjugular-intrahepatic-portosystemic-shunt) within 72 hours of the first endoscopy.
Liver function affects which liver cancer treatments are safe. Guidelines link combination immunotherapy for advanced hepatocellular carcinoma to people with Child-Pugh class A liver function. AASLD advises against routine cancer surveillance for people with class C cirrhosis who cannot have a transplant.
The simplified hepatitis C treatment pathway excludes people with a Child-Pugh score above 7, which counts as decompensated cirrhosis. These patients need care from a liver specialist.
CIRRHOSIS SEVERITY GROUPS
Each class groups people by how advanced their cirrhosis is. Your own outlook depends on more than the class.
A class is a snapshot. It can change over time, and your care team repeats the score when your labs or symptoms change.
CIRRHOSIS SCORE DIFFERENCES
Both scores describe advanced liver disease. They work differently.
| Feature | Child-Pugh Score | MELD Score |
|---|---|---|
| Result | Class A, B, or C | A number, with higher meaning higher risk |
| Inputs | Lab results plus findings such as ascites and encephalopathy | Bilirubin, creatinine, and INR; MELD-Na adds sodium |
| Best known for | Grouping cirrhosis severity and guiding treatment choices | Prioritizing people for liver transplant |
| Level of detail | Three broad classes | A finer-grained number |
Guidelines describe MELD as giving more detailed risk estimates than Child-Pugh, which has known limitations. Doctors often use both.
QUESTIONS FOR YOUR CARE TEAM
Ask which class you are in and what number sits behind it. Ask what drove the score, such as albumin, bilirubin, clotting, fluid in the abdomen, or confusion. Then ask how often the score will be rechecked and what would change your plan.
Ask whether the score affects your treatment choices, such as surgery, liver cancer testing, or hepatitis C therapy. Ask whether you should be evaluated for a liver transplant, and whether your care team also tracks your [MELD score](/liver-tests/medical-scores/liver-severity-cirrhosis-scores/meld-score).
Call your care team right away if you notice new swelling in your abdomen, yellowing of your skin or eyes, confusion, or vomiting blood or black stools. These can signal decompensation. If symptoms are severe, seek emergency care.
A balanced, liver-friendly diet supports your liver, helps manage weight and blood sugar, and lowers the risk of other health problems during long-term follow-up.
Explore Diet & NutritionThe Amsety Bar is a liver-friendly snack or meal replacement that can make it easier to eat well on busy days.
Shop Amsety Bars
COMMON QUESTIONS
The Child-Pugh score is a system that places people with cirrhosis into class A, B, or C to show how advanced their liver disease is. Doctors also call it the Child-Turcotte-Pugh score. A higher class means more advanced disease. Your care team builds the score from blood tests and findings from your exam. Albumin, bilirubin, and INR show how well your liver is working. Signs of complications, such as fluid in the abdomen (ascites) and confusion from hepatic encephalopathy, also count. No biopsy or scan is needed to calculate it. The score does not diagnose cirrhosis. Doctors confirm cirrhosis first, and then use the score to describe how severe it is.
Class C is the most advanced group, with a score of 10 to 13. It often goes along with complications of decompensated cirrhosis, such as ascites, bleeding from enlarged veins (varices), hepatic encephalopathy, or jaundice. People in this class are considered high risk when standard treatment for variceal bleeding may not work. For them, doctors may consider an early TIPS procedure within 72 hours of the first endoscopy. Class C also affects which liver cancer tests and treatments are advised. Your outlook depends on more than the class. It also depends on the cause of your liver disease, your other health conditions, and your treatment options. Ask your care team what class C means for you.
Class A is the least severe group, and it is linked with compensated cirrhosis. In compensated cirrhosis, liver function is better preserved and there are no obvious complications yet. Class A does not mean the scarring has gone away. Cirrhosis is permanent. Staying in class A is the goal, and your care team can help you protect your liver. Treating the cause of your liver disease and avoiding alcohol are common ways to do that. Class A can also open up more treatment choices. For example, guidelines link combination immunotherapy for advanced hepatocellular carcinoma to people with class A liver function.
Yes. Your class is a snapshot of how your liver is working right now. It can change as your liver function or complications change, which is why your care team repeats the score when your labs or symptoms change. A change can go either way. New fluid in the abdomen, confusion, or worse blood test results may move you to a higher class. Treating the cause of liver disease and avoiding alcohol can help protect your liver. Ask your care team how often your score will be rechecked and what would change your plan. Call them right away if you notice new swelling in your abdomen, yellowing of your skin or eyes, confusion, vomiting blood, or black stools.
No. They measure related things in different ways. Child-Pugh gives a class (A, B, or C). MELD gives a number built from bilirubin, creatinine, and INR, and MELD-Na also adds sodium. A higher MELD number means higher risk. Child-Pugh is best known for grouping cirrhosis severity and guiding treatment choices. MELD is used to prioritize people for liver transplant. Because MELD is a finer-grained number, guidelines describe it as giving more detailed risk estimates than Child-Pugh, which has known limitations. Doctors often look at both, along with your symptoms and overall health. You can read more on the MELD Score and MELD-Na Score pages.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
