Nazer et al developed a prognostic index for a patient with Wilson's Disease and fulminant hepatic failure. This was modified to use the INR in place of the prothrombin time (PT). The authors are from King's College Hospital in London.
Patient selection: Wilson's disease and fulminant hepatitis
Parameters:
(1) serum total bilirubin in µmol/L
(2) serum AST in IU/L
(3) INR (International Normalized Ratio)
|
Parameter |
Finding |
Points |
|
serum total bilirubin |
< 100 µmol/L |
0 |
|
|
100 to 150 µmol/L |
1 |
|
|
151 to 200 µmol/L |
2 |
|
|
201 to 300 µmol/L |
3 |
|
|
> 300 |
4 |
|
serum AST |
< 100 |
0 |
|
|
100 to 150 IU/L |
1 |
|
|
151 to 200 IU/L |
2 |
|
|
201 to 300 IU/L |
3 |
|
|
> 300 IU/L |
4 |
|
INR |
< 1.3 |
0 |
|
|
1.3 to 1.6 |
1 |
|
|
1.7 to 1.9 |
2 |
|
|
2.0 to 2.4 |
3 |
|
|
> 2.4 |
4 |
where:
• The changes are assumed to be due to the liver disease and not another cause.
• The comparable PT results: prolongation < 4 seconds (0 points), 4 to 8 seconds (1 point), 9 to 12 seconds (2 points), 13 to 20 seconds (3 points) and >20 seconds (4 points)
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the more severe the liver disease.
• A score >= 7 indicates a high risk of mortality without a liver transplantation.
Purpose: To evaluate a patient with Wilson's disease and fulminant hepatic failure using a modification of the score of Nazer et al.
Specialty: Gastroenterology
Objective: laboratory tests, other testing, severity, prognosis, stage
ICD-10: E83.0,
