Schindl et al reported a score for grading the severity of hepatic dysfunction following a major hepatic resection based on a number of clinical and laboratory findings. The authors are from the Royal Infirmary in Edinburgh.
Patient selection: major hepatic resection
Parameters:
(1) grade of hepatic encephalopathy
(2) serum lactate in mmol/L
(3) serum total bilirubin in µmol/L
(4) prothrombin time in seconds above normal (prothrombin time minus “normal”)
Parameter
Finding
Points
grade of hepatic encephalopathy
none
0
grade 1 or 2
1
grade 3 or 4
2
serum lactate
<= 1.5 mmol/L
0
1.6 to 3.5 mmol/L
1
> 3.5 mmol/L
2
serum total bilirubin
<= 20 µmol/L
0
21 to 60 µmol/L
1
> 60 µmol/L
2
PT above normal
< 4 seconds
0
4 to 6 seconds
1
> 6 seconds
2
where:
• The “normal” value for the prothrombin time could be pegged to the upper limit of the normal reference range or to the mean value.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the more severe the hepatic dysfunction.
Total Score
Severity of Hepatic Dysfunction
0
none
1 or 2
mild
3 or 4
moderate
5 to 8
severe
To read more or access our algorithms and calculators, please log in or register.
