What is the difference between Child-Pugh and MELD?

Child-Pugh classifies cirrhosis into three classes (A, B, C) using clinical and laboratory variables, whereas MELD is a continuous score based on bilirubin, INR, and creatinine (plus sodium in MELD-Na) used to prioritize organ allocation for transplantation.

What does Child-Pugh class C cirrhosis mean?

It indicates decompensated cirrhosis with severely impaired liver function and a worse prognosis, with an estimated 1-year survival around 45%; it typically prompts evaluation for liver transplantation.

Do I need to fast to calculate the Child-Pugh score?

No. It is calculated from laboratory values (bilirubin, albumin, INR) and the clinical assessment of ascites and encephalopathy; no specific fasting is required beyond any lab instructions for the blood draw.

Child-Pugh — Cirrhosis severity and 1-year survival (Pugh 1973).

What it is and when to use it

The Child-Pugh classification estimates the severity and prognosis of hepatic cirrhosis and helps stratify the risk of mortality and perioperative complications. It combines five variables: serum bilirubin, serum albumin, INR (or prothrombin time), ascites, and hepatic encephalopathy. Each variable scores 1 to 3 points, for a total of 5 to 15 points. It is a long-standing tool widely used in hepatology; EASL guidance recognizes it as a classic measure of liver function, often complemented by MELD in transplant evaluation.

How to interpret it

The total score (5–15) divides into three classes. Class A (5–6 points): well-compensated cirrhosis, estimated 1-year survival around 95–100%. Class B (7–9 points): significant functional compromise, 1-year survival roughly 80%. Class C (10–15 points): decompensated disease, 1-year survival around 45%. The class also informs surgical risk and dose adjustment of hepatically metabolized drugs.

Limitations and when not to use it

Validated in patients with chronic cirrhosis. It includes two subjective components (degree of ascites and encephalopathy) that introduce interobserver variability, and it omits renal function, a key prognostic factor that MELD captures. Bilirubin may be artificially elevated in cholestasis or syndromes such as Gilbert's, and albumin and INR can be altered by extrahepatic causes (nutrition, anticoagulation). It does not directly assess the presence of varices or the risk of bleeding from portal hypertension, nor does it replace MELD for transplant waitlist prioritization.

Frequently asked questions

What is the difference between Child-Pugh and MELD?: Child-Pugh classifies cirrhosis into three classes (A, B, C) using clinical and laboratory variables, whereas MELD is a continuous score based on bilirubin, INR, and creatinine (plus sodium in MELD-Na) used to prioritize organ allocation for transplantation.
What does Child-Pugh class C cirrhosis mean?: It indicates decompensated cirrhosis with severely impaired liver function and a worse prognosis, with an estimated 1-year survival around 45%; it typically prompts evaluation for liver transplantation.
Do I need to fast to calculate the Child-Pugh score?: No. It is calculated from laboratory values (bilirubin, albumin, INR) and the clinical assessment of ascites and encephalopathy; no specific fasting is required beyond any lab instructions for the blood draw.