Liver Failure Definitions and Scoring Systems

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]