Unifying Concepts

Child-Pugh Classification of Severity of Liver Disease

Modified Child-Pugh classification of severity of liver disease according to the degree of ascites, the plasma concentrations of bilirrubin and albumin, the prothrombin time, and the degree of encephalopathy.


Parameter Points assigned
1 2 3
Ascites Absent Slight Moderate
Bilirrubin, mg/dL </= 2 2-3 >3
Albumin, g/dL >3.5 2.8-3.5 <2.8

Prothrombin time

* Seconds over control








Encephalopathy None Grade 1-2 Grade 3-4

A total score of 5-6 is considered grade A (well-compensated disease); 7-9 is grade B (significant functional compromise); and 10-15 is grade C (descompensated disease). These grades correlate with one- and two-year patient survival.

Grade Points One-year patient survival (%) Two-year patient survival (%)
A: well-compensated disease 5-6 100 85
B: significant functional compromise 7-9 80 60
C: descompensated disease 10-15 45 35



  1. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646-9. [Medline]
  2. Lucey MR, Brown KA, Everson GT, Fung JJ, Gish R, Keeffe EB, Kneteman NM, Lake JR, Martin P, McDiarmid SV, Rakela J, Shiffman ML, So SK, Wiesner RH. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997 Nov;3(6):628-37. [Medline]


Created: February 16, 2006

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