Description

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.

 


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