Koch et al developed a model for predicting transplant-free survival for a patient with acute liver failure (ALF). This can help to identify a patient who may benefit from more aggressive management including early liver transplantation. The authors are from the Medical University of South Carolina and the University of Texas Southwestern Medical Center and belong to the Acute Liver Failure Study Group (ALFSG).
Patient selection: acute liver failure
Outcome: transplant-free survival at 21 days
Parameters:
(1) hepatic encephalopathy
(2) etiology of liver failure
(3) vasopressor use
(4) serum total bilirubin in mg/dL
(5) INR
Parameter
Finding
Points
hepatic encephalopathy
mild (Grades 1 or 2)
0
deep (Grades 3 or 4)
-0.95
etiology
favorable (acetaminophen overdose, pregnancy, ischemia, hepatitis A)
1.56
all other causes
0
vasopressor use
no
0
yes
-1.25
serum total bilirubin
-0.7 * LN(bilirubin)
INR
- 1.35 *LN(INR)
X =
= SUM(points for all 5 parameters) + 2.67
predicted 21 day transplant-free survival =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.84.
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