Theocharidou et al reported the Royal Free Hospital (RFH) Score for evaluating a patient with cirrhosis admitted to the intensive care unit (ICU). This can help to identify a patient who may require more aggressive management. The authors are from the Royal Free Hospital and University College London.


Patient selection: patient with cirrhosis admitted to the ICU


Parameters on day of ICU admission:

(1) variceal bleeding

(2) serum total bilirubin in µmol/L

(3) INR

(4) serum urea in mmol/L (the paper makes reference to µmol/L)

(5) lactate in mmol/L

(6) A-a gradient (alveolar-arterial partial pressure oxygen gradient) with PaO2 in kPA)


RFH score =

= (0.003 * (serum total bilirubin)) + (0.358 * (INR)) + (0.136 * (lactate)) + (0.004 * (A-a gradient)) + (0.036 * (urea)) – (0.996 if variceal bleeding present)) – 2.692



• A score >= -0.82 was associated with increased mortality.



• The sensitivity was 86% and specificity 59%.

• The positive predictive value was 71% and negative predictive value 78%.


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