Child-Pugh Score

If you have liver cancer, the Child-Pugh classification system assesses how well your liver is working.

What is the Child-Pugh score?

If you have liver cancer, doctors assess how well your liver is working using the Child-Pugh classification system.

Child-Pugh looks at:

  • the level of a waste product (called bilirubin) in the blood
  • the level of a protein (called albumin) in the blood
  • how quickly your blood clots
  • whether there is any build-up of fluid in the tummy area (abdomen), called ascites
  • whether liver damage is affecting how the brain is working (encephalopathy).

The results help doctors decide which treatments are best for your situation. Having certain treatments will depend on how well the liver is able to cope. They will also look at the stage of the cancer when planning your treatment.

What are the Child-Pugh groups?

Based on this, people fall into 1 of 3 groups:

  • A – the liver has some damage, but is working normally.
  • B – there is some damage to the liver, affecting how well it works.
  • C – the liver is very damaged and is not working well. It may not be able to cope with treatment for the cancer.


About our information

  • References

    Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at

    Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: [accessed Feb 2020] 

    NICE. Lenvatinib for untreated advanced hepatocellular carcinoma: Technology appraisal guidance (TA 551) [Internet]. 2018. Available from: [accessed Feb 2020] 

    NICE. Liver disease. Quality standard (QS 152) [Internet]. 2017. Available from: [accessed Feb 2020] 

    NICE. Liver cancers overview [Internet]. 2019. Available from: [accessed Feb 2020]

    NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: [accessed Feb 2020]

    Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from [accessed Feb 2020]    

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 30 June 2020
Next review: 30 June 2023

This content is currently being reviewed. New information will be coming soon.

Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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