LiFe Score of Edmark et al for a Critically-Ill Patient with Acute-on-Chronic Liver Injury

Description

Edmark et al developed the LiFe (liver injury and failure evaluation) score to evaluate patients with acute-on-chronic liver injury in the intensive care unit (ICU). This can help to identify a patient who may benefit from more aggressive management. The authors are from Karolinska Institute, Kings College Hospital, University Hospital Birmingham and Brigham and Women's Hospital.

Patient selection: acute-on-chronic liver disease in the ICU

Outcome acute-on-chronic liver failure (ACLF)

Parameters:

(1) arterial lactate in mg/dL

(2) INR

(3) total seum bilirubin in mg/dL

Parameter	Finding	Points
arterial lactate	0 to 1.9 mg/dL	0
	2.0 to 3.9 mg/dL	3
	4.0 to 5.9 mg/dL	3
	>= 6.0 mg/dL	8
INR	0 to 1.9	0
	2.0 to 3.9	2
	4.0 to 5.9	4
	>= 6.0	3
total bilirubin	0 to 1.9 mg/dL	0
	2.0 to 3.9 mg/dL	3
	4.0 to 5.9 mg/dL	3
	>= 6.0 mg/dL	8

where:

• The ranges for each of the 3 parameters is the same. Point assignment for arterial lactate and total bilirubin are the same. The 2 intermediate levels for lactate and bilirubin can be combined into 1.

• The risk for an INR >= 6 is less than for an INR from 4.0 to 5.9.

Interpretation:

• minimum score: 0

• maximum score: 20

• The higher the score the worse the prognosis.

Total Score	Risk Group	In-Hospital Mortality
0	low	12 to 17%
1 to 3	intermediate	23 to 28%
4 to 8	high	39 to 47%
9 to 20	very high	64 to 77%

from derivation and validation cohorts in Table 2

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LiFe Score of Edmark et al for a Critically-Ill Patient with Acute-on-Chronic Liver Injury

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