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]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
