Kumar et al reported an Acute Liver Failure Early Dynamic (ALFED) model. This can help to predict outcome for a patient with acute liver failure. The authors are from All India Institute of Medical Sciences in New Delhi.
Patient selection: acute liver failure
Parameters based on findings seen over the 3 days after admission:
(1) hepatic encephalopathy
(2) INR
(3) arterial ammonia in µmol/L
(4) serum total bilirubin in mg/dL
|
Parameter |
Finding |
Points |
|
hepatic encephalopathy |
absent |
0 |
|
|
persistentlyGrade 3 or 4 |
2 |
|
|
progressing to Grade 3 or 4 |
2 |
|
|
other |
0 |
|
INR |
persistently >= 5 |
1 |
|
|
progessing to >= 5 |
1 |
|
|
other |
0 |
|
arterial ammonia |
persistently >= 123 µmol/L |
2 |
|
|
progressing to >= 123 µmol/L |
2 |
|
|
other |
0 |
|
serum total bilirubin |
persistently >= 15 mg/dL |
1 |
|
|
progressing to >= 15 mg/dL |
1 |
|
|
other |
0 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the worse the prognosis.
|
Score |
Risk Group |
Mortality Rate |
|
0 or 1 |
low risk |
2-3% |
|
2 or 3 |
moderate risk |
29-37% |
|
4 to 6 |
high risk |
80-96% |
Performance:
• The area under the ROC curve was 0.91.
Specialty: Gastroenterology
