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Child-Pugh score A, B and C: what it means for your liver | CION Cancer Clinics
Child-Pugh is a score of how well a liver with cirrhosis is still working. Class A means the liver is coping, class B means it is struggling, and class C means it is badly strained. It does not measure the cancer itself. This page explains the five things it looks at, how the points add up, and what your class means for the conversation about treatment. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What do Child-Pugh A, B and C actually mean?
- Which five things does the Child-Pugh score look at?
- How do the points turn into a letter?
- What does each class usually say about the liver?
- What do families often get wrong about Child-Pugh?
- What can this page not tell you?
- Common questions about the Child-Pugh score
The short answer
What do Child-Pugh A, B and C actually mean?
Child-Pugh is a score of how well a liver with cirrhosis is still working. Class A means the liver is coping well, class B means it is struggling, and class C means it is badly strained. It does not measure the cancer at all. It measures the liver the cancer is sitting in.
Why a cancer page talks about the liver
Most primary liver cancer, called hepatocellular carcinoma or HCC, grows in a liver that is already scarred by cirrhosis. That scarred liver has to survive whatever treatment is chosen. So doctors need two answers before they plan anything: how big and how widespread is the tumour, and how much working liver is left. Child-Pugh answers the second question.
Who this page is for
This page is about primary liver cancer in a person with cirrhosis. If you were told cancer has spread to the liver from the bowel, breast or elsewhere, the liver underneath is usually healthy and Child-Pugh is rarely used. Read the two very different things called liver cancer first.
Child-Pugh describes the liver, not the tumour. A small tumour in a class C liver and a large tumour in a class A liver are very different situations.What goes into it
Which five things does the Child-Pugh score look at?
Three come from a blood test. Two come from what the doctor sees and asks about. Each one gets a small number of points.
Bilirubin
The yellow pigment the liver normally clears into bile. When it builds up in the blood, the skin and eyes turn yellow, which is jaundice. A higher level earns more points.
Albumin
The main protein the liver makes for the blood. A struggling liver makes less of it, so a low albumin earns more points. This is one reason families should not cut protein from the diet without advice.
INR
A measure of how quickly blood clots. The liver makes the clotting proteins, so a slow-clotting result, a high INR, suggests the liver is falling behind. Some reports show prothrombin time instead.
Ascites
Fluid collecting in the abdomen. None, a little that tablets control, or a lot that is hard to control each score differently.
Hepatic encephalopathy
Confusion, drowsiness or a change in personality caused by toxins the liver is not clearing. None, mild, or more severe each carry a different score.
Why two are judgement calls
- Fluid and confusion are judged by the doctor, not a machine
- Treatment with tablets can change how they are scored
- Two doctors can occasionally land on different classes
Not sure whether this applies to you?
Ask an oncologistAdding it up
How do the points turn into a letter?
Each measure gets one, two or three points
One point means that part of the liver is working normally or close to it. Three points means it is badly affected. Nothing is ever scored zero.
The five scores are added together
So the lowest possible total is five points and the highest is fifteen. Your doctor or the report may write the total, the letter, or both, for example "Child-Pugh A6" or "B7".
The total is placed in a class
Five or six points is class A. Seven to nine is class B. Ten to fifteen is class C. The number after the letter tells you where in the class you sit, which matters most in class B.
The score is repeated over time
Child-Pugh is a snapshot. An infection, bleeding or a drink can push it up for a while, and treating those causes can bring it down again. Doctors usually look at the trend, not one reading.
In plain words
What does each class usually say about the liver?
- Child-Pugh A
- The liver is scarred but still doing its job. Many people feel well and have no jaundice, fluid or confusion. Most liver cancer treatments remain possible.
- Child-Pugh B
- The liver is under strain. There may be some jaundice, some fluid, or low albumin. Treatment choices narrow, and a low B is handled very differently from a high B.
- Child-Pugh C
- The liver is struggling badly. Fluid, jaundice or confusion are often present. Treatment aimed at the tumour can harm the liver more than it helps, so care often focuses on the liver itself.
- Compensated
- Cirrhosis that is not yet causing fluid, bleeding, jaundice or confusion. It usually lines up with class A.
- Decompensated
- Cirrhosis that has started to cause those problems. It usually lines up with class B or C. See compensated versus decompensated cirrhosis.
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Commonly believed
What do families often get wrong about Child-Pugh?
"Class C means the cancer is at its last stage."
Child-Pugh grades the liver, not the cancer. A person can have a small tumour and a class C liver. The class matters because it limits what the liver can withstand, and that is a separate question from how far the tumour has grown.
"The letter is fixed once it is written down."
It can move in both directions. Treating an infection, draining fluid, controlling hepatitis B, or stopping alcohol can improve it. A bleed or a new infection can make it worse within days.
"Low albumin means we should stop eating protein."
The opposite is usually true. People with cirrhosis often need more protein, not less, to hold on to muscle. Diet changes should come from the care team, not from a relative's advice.
"The score tells us how long he has."
The score was built to describe groups of patients. It cannot predict one person's future, and your doctors will not use it that way. Ask what it means for treatment, which is the question it is designed to answer.
Being straight with you
What can this page not tell you?
It cannot tell you your own class. That needs the actual blood results, an examination for fluid and confusion, and a doctor who knows what treatment has already been given. Adding up the points from a report at home often goes wrong, because the two judgement measures are easy to misread.
It is one measure among several
Your team will also look at the albumin, INR and platelets on their own, the size of the spleen, signs of raised pressure in the liver's blood vessels, and how active and strong the person is day to day. Transplant centres use a different score, the MELD score, for their own decisions.
Who this does not apply to
If the liver has no cirrhosis, as in most secondary liver cancer and some HCC in a healthy-looking liver, Child-Pugh says little. If you are unsure which group you are in, ask your oncologist directly. To see how the class shapes the plan, read why Child-Pugh decides what treatment you can have.
Bring every recent blood report and scan to the consultation. The trend is often more useful than the latest number.Questions we are asked
Common questions about the Child-Pugh score
Is Child-Pugh the same as the cancer stage?
No. Stage describes the tumour: its size, number and spread. Child-Pugh describes the liver around it. The BCLC system used for liver cancer brings both together with how active the person is, which is why the class appears inside the stage your doctor gives.
What does A5 or A6 mean on my report?
The letter is the class and the number is the total points. A5 is the lowest possible score and means every measure looks close to normal. A6 means one measure has slipped a little. Both count as class A, and the liver is coping.
Can Child-Pugh B improve back to A?
Sometimes. If the slip was caused by something treatable, such as an infection, a bleed, active hepatitis B or recent drinking, the score can come back down once that is dealt with. If it is simply the cirrhosis advancing, improvement is less likely. Your team will usually repeat the tests before deciding.
Why did two doctors give different classes?
Fluid and confusion are graded by judgement, and blood results change from week to week. Tablets for fluid or confusion can also change how those items are scored. A one-class difference is not unusual. Ask each doctor which measures they scored and when the blood was taken.
Does Child-Pugh apply if I do not have cirrhosis?
It was designed for cirrhosis. Without cirrhosis, most points come out low and the score adds little. Doctors then rely more on the blood tests on their own, the scans and how well the person is. This is common in secondary liver cancer.
Is the ALBI grade replacing Child-Pugh?
ALBI is a newer measure built only from albumin and bilirubin, so it avoids the two judgement calls. Some teams use it alongside Child-Pugh, especially to split class A more finely. It has not replaced Child-Pugh in most guidelines. Ask your team which one they are using.
Does a class C liver mean nothing can be done?
It means treatments aimed at the tumour are often too risky. A great deal can still be done for the liver and for symptoms such as fluid, itching and confusion. For a small group, transplant assessment may be considered. Ask the team what is still possible for the person, not only the tumour.
Who works out the score, and can CION review it?
Your hepatologist or oncologist calculates it from blood tests and an examination. CION's tumour board can review the reports, scans and class alongside your own team, and explain what it means for the treatment plan. Call the CION helpline and bring the recent reports.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MDCalc — Child-Pugh Score for Cirrhosis Mortality Calculator
- Cancer Research UK — Stages of liver cancer
- National Cancer Institute — Liver Cancer Stages
- Liver UK (formerly British Liver Trust) — Cirrhosis
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why Child-Pugh decides what treatment you can haveThe next step: how the class shapes the planThe MELD score and what it is used forThe other liver score, used for transplantAlbumin, INR and plateletsThe blood numbers behind the scoreWhy liver cancer uses BCLCHow liver function sits inside the stage
Talk to us
Not sure what the Child-Pugh class on the report means?
Send us the recent blood reports and scans, and the tumour board can explain what the liver function means for the treatment plan. One helpline serves every CION centre.