The Child–Pugh (Child–Turcotte–Pugh) classification grades chronic liver disease, mainly cirrhosis, into classes A, B and C using encephalopathy, ascites, bilirubin, albumin and coagulation.

Child and Turcotte first described a hepatic function classification in surgical patients undergoing portal decompression in the 1960s; Pugh and colleagues later modified it in 1973 by replacing nutritional status with prothrombin time/INR and formalising the current 1–3 point weighting for each variable.

Child–Pugh class	Score	Approx. 1-year survival	Approx. 2-year survival
A	5–6	~100%	~85%
B	7–9	~80%	~60%
C	10–15	~45%	~35%

These survival estimates come from early cirrhosis cohorts; absolute outcomes have improved with modern care, but the risk gradient between classes remains clinically useful.

Child–Pugh class is widely used to describe hepatic reserve, estimate medium-term mortality and bleeding risk, and inform decisions about non-hepatic surgery, transjugular intrahepatic portosystemic shunt (TIPS) procedures and timing of transplant referral. MELD/MELD-Na now underpin formal liver transplant allocation in many systems, so Child–Pugh should be viewed as a complementary bedside staging tool rather than a replacement.

Limitations include the subjectivity of ascites and encephalopathy grading, variability with diuretics, paracentesis and encephalopathy treatment, and reduced accuracy in some specific aetiologies. Standard bilirubin cut-offs were derived for typical cirrhosis and may misclassify predominantly cholestatic disease; local hepatology services may recommend modified cut-offs in these settings.

Use primarily in adults with established chronic liver disease or cirrhosis. It is not validated for acute liver failure or paediatric populations.

Child-Pugh Score for Cirrhosis Mortality