Liver Failure Definitions and Scoring Systems

Reviewed and revised 11 November 2016


  • 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


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 points3 points
>3528-35 <28
(responds to diuretics)
(refractory to diuretics)
 EncephalopathyNoneGrade I-IIGrade II-IV


  • 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]

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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