Child-Turcotte-Pugh (CTP) Score Calculator
Calculate the standard five-domain Child-Turcotte-Pugh score and class for established cirrhosis using bilirubin, albumin, INR or PT prolongation, ascites, and encephalopathy.
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About
The Child-Turcotte-Pugh (CTP) score is a five-domain categorical description used in established cirrhosis and in protocols that explicitly request CTP class. This page implements the standard total-bilirubin table published by the U.S. Department of Veterans Affairs and accepts either INR or prothrombin-time prolongation as the single coagulation domain. [1, 2, 3]
It does not diagnose cirrhosis, calculate the current U.S. transplant-allocation score, estimate an individual survival probability, or decide surgery, medication eligibility, dose, monitoring, referral, admission, or treatment. Current U.S. liver allocation uses MELD rather than conversion of a CTP class. [8, 10, 11]
Interpretation
| Score | Class | Safe interpretation |
|---|---|---|
| 5–6 | A | Lowest of the three formal CTP classes. It is not a declaration of normal liver function or absence of clinically important cirrhosis. [1, 2] |
| 7–9 | B | Middle formal CTP class. The class alone does not specify an intervention, drug dose, or individual prognosis. [2, 3] |
| 10–15 | C | Highest formal CTP class. Urgent clinical decisions still require the diagnosis, current complications, trajectory, organ function, and applicable pathway. [2, 4] |
What the five domains mean
Bilirubin reflects pigment clearance and excretion; albumin is a circulating protein synthesized by the liver; INR or PT prolongation reflects the selected coagulation measure; ascites is fluid in the abdomen; and hepatic encephalopathy is brain dysfunction attributed to liver disease. A laboratory result cannot substitute for the documented clinical grading of ascites or encephalopathy. [2, 5, 6]
Use one documented clinical time point
Use laboratory and examination findings from the intended assessment time. Albumin infusion, anticoagulants, plasma products, diuretics, paracentesis, lactulose, rifaximin, sedation, intubation, infection, bleeding, kidney injury, and other acute events can change or confound one or more domains. Record those circumstances instead of treating the score as context-free. [3, 4, 7]
INR and PT are alternatives
Choose one coagulation basis. PT prolongation means seconds above the laboratory control, not the patient’s raw PT. INR and PT bands must not both be added. Anticoagulant-associated INR elevation can make the standard score misleading. [2, 3, 10]
Ascites and encephalopathy are treatment-sensitive
The standard table distinguishes diuretic-responsive from diuretic-refractory ascites and grades encephalopathy using documented clinical severity. These domains introduce subjectivity and can change after treatment, so a score should identify who graded it, when, and under what treatment state. [4, 5, 6, 7]
CTP and MELD answer different questions
CTP includes two clinical judgments and three categorical laboratory domains. MELD models use different variables and equations. The current U.S. allocation system does not arise by converting a CTP class. For a separate version-specific MELD calculation, see the MELD 3.0, MELD-Na & Classic MELD calculator. [8, 11]
A class is not a universal survival percentage
Outcomes vary by population, cause of cirrhosis, compensated or decompensated state, acute complications, treatment, follow-up interval, and study era. This page therefore does not attach a fixed mortality or survival percentage to any class and does not convert a cohort association into an individual probability. [3, 8, 9]
Drug labels and protocols remain product-specific
CTP categories appear in hepatic-impairment studies and some product labeling, but this calculator does not decide whether a drug is indicated, contraindicated, or dose-adjusted. Use the exact product label or protocol, including its specified CTP table, population, exclusions, and timing. [3, 10]
References
- Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–649. PMID 4541913. DOI 10.1002/bjs.1800600817.
- U.S. Department of Veterans Affairs. Child-Turcotte-Pugh (CTP) Calculator — Cirrhosis. Standard five-domain table and class boundaries.
- Garcia-Tsao G. The Child-Turcotte Classification: From Gestalt to Sophisticated Statistics and Back. Clin Liver Dis (Hoboken). 2016;8(6):149–151. PMID 27696097. PMCID PMC5218597.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460. PMID 29653741. DOI 10.1016/j.jhep.2018.03.024.
- Biggins SW, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014–1048. PMID 33942342. DOI 10.1002/hep.31884.
- Vilstrup H, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by AASLD and EASL. Hepatology. 2014;60(2):715–735. PMID 25042402. DOI 10.1002/hep.27210.
- de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII — Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–974. PMID 35120736. PMCID PMC11090185. DOI 10.1016/j.jhep.2021.12.022.
- Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs AK. Systematic review: the model for end-stage liver disease — should it replace Child-Pugh's classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther. 2005;22(11–12):1079–1089. PMID 16305721. DOI 10.1111/j.1365-2036.2005.02691.x.
- D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217–231. PMID 16298014. DOI 10.1016/j.jhep.2005.10.013.
- U.S. Food and Drug Administration. Pharmacokinetics in Patients with Impaired Hepatic Function: Study Design, Data Analysis, and Impact on Dosing and Labeling. Final Guidance. May 2003. Docket FDA-1999-D-0063.
- HRSA/OPTN MELD calculator, reviewed December 2025. Current U.S. liver allocation uses the MELD model rather than conversion of a Child-Pugh class.
FAQ
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Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.