Naiki et al developed a score for evaluating patients in Japan with acute liver failure (ALF). This can help to identify a patient who may benefit from liver transplantation. The authors are from multiple universities in Japan and belong to the Intractable Hepato-Biliary Disease Study Group.
Patient selection: acute liver failure
Parameters:
(1) number of days between onset of hepatitis and development of hepatic encephalopathy
(2) prothrombin time in percent
(3) total bilirubin in mg/dL
(4) ratio of direct to total bilirubin concentration
(5) platelet count per µL
(6) liver atrophy
Parameter
Finding
Points
interval between onset and encephalopathy
<= 5 days
0
6 to 10 days
1
>= 11 days
2
prothrombin time in percent
> 20%
0
5.1 to 20%
1
<= 5%
2
total bilirubin
< 10 mg/dL
0
10 to 14.9 mg/dL
1
>= 15 mg/dL
2
ratio direct to indirect bilirubin
>= 0.70
0
0.50 to 0.69
1
< 0.50
2
platelet count
> 100,000 per µL
0
50,001 to 100,000 per µL
1
<= 50,000 per µL
2
liver atrophy
absent
0
present
1
where:
• Prothrombin time in percent appears to refer to coagulation activity. As the percent declines the prothrombin time (PT) becomes prolonged. Factor VII activity might correlate with this.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the greater the mortality.
Total Score
Mortality
0
0%
1
8%
2
20%
3
24%
4
56%
5
74%
6
86%
7
91%
8
96%
>= 9
90%
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