Naiki et al developed a score for evaluating patients in Japan with acute liver failure (ALF). This can help to identify a patient who may benefit from liver transplantation. The authors are from multiple universities in Japan and belong to the Intractable Hepato-Biliary Disease Study Group.
Patient selection: acute liver failure
Parameters:
(1) number of days between onset of hepatitis and development of hepatic encephalopathy
(2) prothrombin time in percent
(3) total bilirubin in mg/dL
(4) ratio of direct to total bilirubin concentration
(5) platelet count per µL
(6) liver atrophy
Parameter |
Finding |
Points |
interval between onset and encephalopathy |
<= 5 days |
0 |
|
6 to 10 days |
1 |
|
>= 11 days |
2 |
prothrombin time in percent |
> 20% |
0 |
|
5.1 to 20% |
1 |
|
<= 5% |
2 |
total bilirubin |
< 10 mg/dL |
0 |
|
10 to 14.9 mg/dL |
1 |
|
>= 15 mg/dL |
2 |
ratio direct to indirect bilirubin |
>= 0.70 |
0 |
|
0.50 to 0.69 |
1 |
|
< 0.50 |
2 |
platelet count |
> 100,000 per µL |
0 |
|
50,001 to 100,000 per µL |
1 |
|
<= 50,000 per µL |
2 |
liver atrophy |
absent |
0 |
|
present |
1 |
where:
• Prothrombin time in percent appears to refer to coagulation activity. As the percent declines the prothrombin time (PT) becomes prolonged. Factor VII activity might correlate with this.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the greater the mortality.
Total Score |
Mortality |
0 |
0% |
1 |
8% |
2 |
20% |
3 |
24% |
4 |
56% |
5 |
74% |
6 |
86% |
7 |
91% |
8 |
96% |
>= 9 |
90% |
Specialty: Gastroenterology