Reviewed and revised 11 November 2016
DEFINITIONS
- Liver failure
- failure of hepatic synthetic and metabolic function
- Fulminant or severe acute hepatic failure
- liver failure with encephalopathy developing over <8 weeks in previously healthy individuals
- Hyperacute liver failure
- liver failure with encephalopathy developing over <14 days in previously healthy individuals
- Acute liver failure
- liver failure with encephalopathy developing over <26 weeks in previously healthy individuals
- Chronic liver failure
- liver failure without encephalopathy
- Acute on chronic liver failure
- chronic liver failure with the development of encephalopathy
SCORING SYSTEMS FOR CHRONIC LIVER DISEASE SEVERITY
Child-Pugh Score (see MDCALC: Child-Pugh)
- Classified A,B or C
- composite of Total bilirubin, albumin, INR, ascites and hepatic encephalopathy
- Originally used for prognostication for surgery
- also used for prognostication in chronic liver disease and predicting complications of cirrhosis
Variable | 1 point | 2 points | 3 points |
Bilirubin (μmol/L) | <34 | 34-50 | >50 |
Albumin (g/L) | >35 | 28-35 | <28 |
INR | <1.7 | 1.7-2.3 | >2.3 |
Ascites | None | Mild (responds to diuretics) | Severe (refractory to diuretics) |
Encephalopathy | None | Grade I-II | Grade II-IV |
MELD Score (see MDCALC: MELD)
- uses the serum bilirubin, creatinine and INR
- Initially developed to predict three month survival in patients post TIPS
- Now used for prognosis of liver disease and prioritizing liver transplant recipients
- also the PELD score for children <12y (see MDCALC: PELD)
References and links
Journal articles
- Child CG, Turcotte JG. Surgery and portal hypertension. Major problems in clinical surgery. 1:1-85. 1964. [pubmed]
Critical Care
Compendium
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