Risk Stratification

High mortality exists amongst all patients.

Although current scoring systems do not accurately predict the outcome or need for transplantation, there are some factors associated with a poorer outcome. For example, in some patient groups less than 25% survive without transplant, compared to more than 50% in other others [1].

Factors associated with a poor outcome

Table 1: Factors associated with a poor outcome [1-3]
Aetiology
  • Mushroom poisoning
  • Drug reactions
  • Non hepatitis A viral hepatitis
  • Wilson’s disease
  • Autoimmune hepatitis
  • Budd-Chiari syndrome
  • Indeterminate
Admission COMA Grade III or IV
INR > 6.5

Prediction of the need for transplant in paracetamol as aetiology

Table 2: King’s College Criteria showing prediction of the need for transplant in paracetamol [1-3]
Admission COMA Grade Grade III or IV
pH <7.3 following fluid resuscitation
INR > 6.5
Creatinine > 300

Learning bite

Certain aetiologies, COMA and significantly deranged prothombin times put patients into a group more likely to require transplantation.