Child-Pugh class C – what does it mean?
⚠︎ Learning page – classification and study figures only, no treatment recommendation.
In short
Child C covers 10–15 points of the Child-Pugh score (range 5–15). The calculator describes the class as "decompensated cirrhosis"; the MSD Manual assigns it a high risk.
According to the MSD Manual (compiled from cohort studies), 1-year survival in Child C is 41–51% and 2-year survival 27%.
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 C
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
147 of the 243 possible combinations result in Child C. One or two examples per score:
- 10 points (51 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: 1.7–2.3 (2), other parameters 1 point each; Total bilirubin: 2–3 mg/dl (34–50 µmol/l) (2) + Albumin: 2.8–3.5 g/dl (2) + INR: 1.7–2.3 (2) + Ascites: mild or controlled with diuretics (2) + Hepatic encephalopathy: grade 1–2 (2)
- 11 points (45 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3), other parameters 1 point each; Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: 2.8–3.5 g/dl (2) + INR: 1.7–2.3 (2) + Ascites: mild or controlled with diuretics (2) + Hepatic encephalopathy: grade 1–2 (2)
- 12 points (30 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3) + Ascites: mild or controlled with diuretics (2), other parameters 1 point each; Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: 1.7–2.3 (2) + Ascites: mild or controlled with diuretics (2) + Hepatic encephalopathy: grade 1–2 (2)
- 13 points (15 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3) + Ascites: moderate to severe or refractory (3), other parameters 1 point each; Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3) + Ascites: mild or controlled with diuretics (2) + Hepatic encephalopathy: grade 1–2 (2)
- 14 points (5 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3) + Ascites: moderate to severe or refractory (3) + Hepatic encephalopathy: grade 1–2 (2)
- 15 points (1 combinations): Total bilirubin: > 3 mg/dl (> 50 µmol/l) (3) + Albumin: < 2.8 g/dl (3) + INR: > 2.3 (3) + Ascites: moderate to severe or refractory (3) + Hepatic encephalopathy: grade 3–4 (3)
Reports often give the class together with the points, for example "Child C (10 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
Calculate it yourself
Enter the criteria in the Child-Pugh score calculator – it runs only in your browser.
FAQ
How many points is Child C?▾
10 to 15 points. Child A covers 5–6, Child B 7–9 and Child C 10–15 points.
What is the life expectancy in Child C?▾
Individual life expectancy cannot be read from the class. From cohort studies, the MSD Manual gives 1-year survival of 41–51% and 2-year survival of 27% for Child C.
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