Risk Stratification

Acute Liver Failure Clinical Assessment 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.

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