Tests and scorring systems
for cirrhosis
The information on this page is for:
- Adults with cirrhosis or suspected cirrhosis.
- Family, friends, carers, and healthcare professionals.
Find out about advanced liver disease in children
To find out if you have cirrhosis, your doctor will need to do tests and ask you questions.
They will try to find out:
- What might be causing your condition.
- If you have cirrhosis, or if you might have a different condition that needs treatment.
- How much damage (scarring) there is in your liver.
- If you have any complications caused by cirrhosis.
On this page you can find information about the types of tests you might have. There is also information about what your doctor will ask you. And some tips to help you answer their questions.
On this page:
Questions from your doctor
Your doctor will need to ask you some questions to find out if you might be at risk of liver disease. If you have symptoms, they will need to rule out all the other possible causes. It is important to try to answer all the questions honestly.
Liver disease is very common. 9 in 10 cases are caused by things like alcohol and being overweight. Your doctor should be used to talking about these things. It is important to work out what could be causing your liver condition as this will affect what treatment is best for you.
What are your symptoms?
If you have no symptoms, tell the doctor that you are worried you might be at risk and why.
If you have symptoms tell your doctor about all of them. Include anything that has changed or is new or unusual for you, even if it is not really bothering you very much.
You can find out more about symptoms of cirrhosis here
Our tip:
If you have a lot of symptoms, it can help to write them all down before your appointment. You can put the ones that you find worst at the top of the list.
How much alcohol do you drink?
Alcohol is the biggest cause of liver disease in the UK. But not all liver disease is caused by alcohol. Your doctor probably does not know if you drink. So they will need to ask you to see if it could be part of the problem or not.
It is important to give an honest answer so your doctor can decide how to help you.
Our tip:
If you do drink, it might help to work out in advance how much you are drinking. Think through a typical week one day at a time and write down what you would drink and how much.Sometimes it’s helpful to count up what you buy and tell the doctor the amount.You might be asked about “units” of alcohol:
- A pint of 5% beer is 3 units
- A bottle of 13% wine is 10 units
- A single 25ml measure of spirits is 1 unit
What do you weigh?
The second most common type of liver disease is linked to being overweight. People can carry extra body fat in different ways. So it is not always possible to tell if you are at risk just by looking at you.
Your doctor might ask how much you weigh or ask to weigh and measure you. They might also ask you about the types of food that you eat and if you have:
- Type 2 diabetes
- High cholesterol
- High blood pressure.
These conditions can also be linked to your weight. If you have them it is important to have treatment to get them under control.
If you are worried about your weight, some GPs can refer you to services that can help. Getting support makes it more likely that you will be able to make changes and stick with them. Ask what is available in your area. You can find out more about eating, drinking and keeping active here.
Personal questions
Another common cause of liver disease is viral hepatitis. Some types of viral hepatitis are passed on from person to person. Hepatitis B can be passed from mother to baby.
Your doctor might ask questions to see if you could be at risk. Viral hepatitis can go unnoticed for decades. So try to think back and give honest answers. They will ask questions about sex, recreational drugs and if you could have been born with the virus.
Our tip:
If there is any chance you could have picked up viral hepatitis always ask for a test. Your GP or local sexual health clinic should be able to arrange the tests.
Medicines, drugs and supplements
Liver disease can sometimes change the way medicines work. And medicines can sometimes cause liver disease. So your doctor might ask you about any medicines you are taking. It is important to tell them about everything. This includes:
- prescription medicines
- medicines you buy from a pharmacy
- alternative, natural and herbal medicines
- supplements
- weight loss medicines
- recreational drugs
Make a list of all your medicines and supplements before your appointment. Include the dose, this should be written on the packet usually as mg or ug and how often you take it. If you are not sure about the dose or exactly what is in your medicine then take the packet along with you or take a photo of it that you can show to your doctor.
Blood tests
Liver blood test
If your GP wants to check on your liver they will usually ask you to have a test called a liver blood test. This is sometimes called a liver function test or LFT.
This test cannot diagnose liver disease on its own. But it can help your doctor to see how your liver is doing and what other tests you might need.
Find out more about liver blood tests
Full liver screen
If your liver blood test suggested a problem, or you are being treated for possible liver disease in hospital, you might have more blood tests.
Some of these look for problems in your liver. Others are used to rule out other possible conditions.
Which tests you have will depend on your symptoms, risk factors and other test results.
Imaging tests
Ultrasound
An ultrasound scan uses sound waves to build up a picture of your liver that your medical team can look at on screen.
Having the scan should not hurt, it might be a bit uncomfortable if you have tummy pain.
Find out more about ultrasounds
FibroScan
Also called – transient elastography, VCTE
A FibroScan measures how stiff your liver is. A healthy liver is very soft and squishy, but if you have cirrhosis it becomes very tough and knobbly.
Having a FibroScan is quick and painless.
Find out more about FibroScans
CT and MRI scans
Depending on your other test results you might be asked to have another imaging test, such as a CT or MRI scan to take a more detailed look at your liver.
Biopsy
During a liver biopsy a thin needle is used to take a sample of your liver. This can then be looked at in a laboratory to help doctors understand what is happening with your liver. You can have pain relief when the sample is taken. The procedure can usually be done in a day without you having to stay over in hospital.
Endoscopy
An endoscope is a long thin tube with a light and a tiny camera at the end. It can be used to take a look at your digestive system from the inside.
Endoscopy can be used to look for varices. These are veins that can cause serious bleeding. You can find out more about varices here. Endoscopies are also used in some treatments.
Depending on the type of endoscopy you are having, you might have a general anaesthetic or a medicine to help you feel relaxed and sleepy. You might also need to stay in hospital for a short time.
Cirrhosis scoring systems
If your test results show that you have cirrhosis, you might be given a score or classification. These scores are used to work out how much scarring there is. This can help you and your doctor to decide what needs to happen next.
There are 3 main ways of scoring liver cirrhosis in the UK. The Child-Pugh classification, the UKELD score and the MELD score.
The Child-Pugh classification divides liver cirrhosis into 3 classes, A, B and C. The UKELD score and MELD score give you a number.
You can find out more about the Child-Pugh classification, UKELD score, and MELD score in the drop down boxes below.
If you do not have cirrhosis but you are at risk of liver disease you might be given a fibrosis score instead. Find out more about fibrosis scoring systems (FIB-4 and ELF).
What does my score mean?
- Scoring systems were designed to help doctors understand how unwell you are. And to help them make decisions about which treatment options are best for you.
- They cannot tell you exactly what will happen to you. They are based on averages for lots of people.
For example, if you might need a non-urgent operation, doctors might use your Child-Pugh classification to help them work out if the surgery is safe for you. Or if you need more tests to find out.
In the UK the UKELD score is one of the things used to decide who will go on the liver transplant waiting list.
Our tips:
It is tempting to look online to find out what your score means. Cirrhosis scores can be used to get an idea of how long someone might live (prognosis). Or of how likely it is that you will survive some treatments. But it cannot give you a definite answer and everyone is different.
We do not recommend trying to work out your score using an online calculator. These calculators use test results which you may have been given. But your results might not have the right units for the calculator. Some labs also do the tests in slightly different ways, this means there is an extra step needed for the calculator to work.
A cirrhosis score on its own cannot tell you the whole story. If you would like to know your Child-Pugh, UKELD or MELD score, or you are worried about what your score might mean, it is important to talk to your medical team for information that is personal to you.
Find out more about:
Child-Pugh score
The Child-Pugh classification looks at the complications below to see if you have them, and how severe they are:
It also looks at blood test results for:
- bilirubin
- albumin
- prothrombin or INR
INR is a measure of how long it takes for your blood to clot.
For each of these things you will be given a score of 1, 2 or 3 points. Then all the points are added together.
Total score:
5 or 6 points = Child-Pugh class A, well compensated cirrhosis
7 to 9 points = Child-Pugh class B, The liver is struggling and is not able to do all its jobs properly. Some patients with Child-Pugh class B will have decompensated cirrhosis.
10 to 15 points = Child-Pugh class C, decompensated cirrhosis
UKELD score
UKELD stands for United Kingdom model for End-stage Liver Disease. It uses a calculation based on blood test results for:
- INR
- Creatinine
- Bilirubin
- Sodium
If you have long term (chronic) liver disease your UKELD score might be used to work out if you could benefit from a liver transplant. To be put on the transplant waiting list you need a UKELD of 49 or more.
Your UKELD score does not decide how quickly you will be offered a transplant. A more complicated calculation called the transplant benefit score (TBS) is used to decide who gets each donated liver.
UKELD is not used for transplant decisions for people with HCC liver cancer or acute (sudden) liver failure.
MELD score
MELD stands for Model for End-stage Liver Disease. It uses a calculation based on your blood levels of:
- creatinine
- bilirubin
- INR
There are some versions of the MELD score that also add in other things. Including:
- the amount of sodium in your blood
- if you are male or female
- albumin
- age
The calculation gives a MELD score of between 6 and 40.
The more severe your cirrhosis is, the higher your MELD score will be. Your doctor can talk you through your MELD score and how they calculated it.
In some other countries, including the USA, MELD scores are used to make decisions about transplants.
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This content was last reviewed: February 2025
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Dr Vishal Patel, Consultant Hepatologist, Kings College hospital, Dr Victoria Kronsten, Senior Clinical Research Fellow in Hepatology, King’s College Hospital, Katharine Caddick, Consultant Nurse, North Bristol Trust, Maria-Emanuela Maxan, Senior Clinical Research Fellow in Hepatology, King’s College Hospital and Claire Smith, Hepatology Clinical Nurse Specialist. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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