Child-Pugh class A – what does it mean?

⚠︎ Learning page – classification and study figures only, no treatment recommendation.

In short

Child A covers 5–6 points of the Child-Pugh score (range 5–15). The calculator describes the class as "well-compensated cirrhosis"; the MSD Manual assigns it a low risk.

According to the MSD Manual (compiled from cohort studies), 1-year survival in Child A is 90–96% and 2-year survival about 80–88%.

The figures describe groups in the cited studies, not the risk of an individual person. This page contains no treatment or management recommendation.

How to arrive at Child A

Five parameters are scored 1–3 points each:

Total bilirubin: < 2 mg/dl (< 34 µmol/l) = 1, 2–3 mg/dl (34–50 µmol/l) = 2, > 3 mg/dl (> 50 µmol/l) = 3
Albumin: > 3.5 g/dl = 1, 2.8–3.5 g/dl = 2, < 2.8 g/dl = 3
INR: < 1.7 = 1, 1.7–2.3 = 2, > 2.3 = 3
Ascites: none = 1, mild or controlled with diuretics = 2, moderate to severe or refractory = 3
Hepatic encephalopathy: none = 1, grade 1–2 = 2, grade 3–4 = 3

6 of the 243 possible combinations result in Child A. One or two examples per score:

5 points (1 combinations): all five parameters 1 point each
6 points (5 combinations): Total bilirubin: 2–3 mg/dl (34–50 µmol/l) (2), other parameters 1 point each

Reports often give the class together with the points, for example "Child A (5 points)".

Origin of the classification

Pugh et al. published the classification in 1973 in a paper on oesophageal transection for bleeding oesophageal varices; it builds on the earlier classification by Child and Turcotte (hence "Child-Turcotte-Pugh"). The cut-offs A 5–6, B 7–9 and C 10–15 points have remained unchanged since.

Limitations

Ascites and encephalopathy are assessed subjectively, which reduces inter-rater reliability (MSD Manual). The survival rates come from cohort studies and describe groups, not individual life expectancy.

All classes at a glance

Class	Points	Risk	1-year survival	2-year survival
Child A	5–6	low	90–96 %	about 80–88 %
Child B	7–9	moderate	73–78 %	48 to about 60 %
Child C	10–15	high	41–51 %	27 %

Survival rates according to the MSD Manual (compiled from cohort studies, table "Interpretation of the Child-Turcotte-Pugh Scoring System").

Calculate it yourself

Enter the criteria in the Child-Pugh score calculator – it runs only in your browser.

FAQ

How many points is Child A?▾

5 to 6 points. Child A covers 5–6, Child B 7–9 and Child C 10–15 points.

What is the life expectancy in Child A?▾

Individual life expectancy cannot be read from the class. From cohort studies, the MSD Manual gives 1-year survival of 90–96% and 2-year survival of about 80–88% for Child A.

How does Child-Pugh differ from MELD?▾

MELD uses laboratory values only (bilirubin, creatinine, INR). In the waiting-list cohort of Wiesner et al. (2003), it predicted 3-month mortality with a c-statistic of 0.83, compared with 0.76 for the Child-Pugh score.

References

Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–9. · PubMed
MSD Manual Professional Edition: Cirrhosis (Stand 04/2026) – Tabellen „Child-Turcotte-Pugh Scoring System“ und „Interpretation of the Child-Turcotte-Pugh Scoring System“. · msdmanuals.com
Wiesner R et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124:91–6. · PubMed

Learning page for medical education only: classification and figures reported in the cited sources, no treatment or management recommendation, not for use in patients; not a medical device. Last updated: 10/2026 · Dr. Pascal Bafteh