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Home | CCC | Liver Failure Definitions and Scoring Systems

Liver Failure Definitions and Scoring Systems

by Dr Chris Nickson, last update April 23, 2019

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 points3 points
Bilirubin
(μmol/L)
<3434-50>50
Albumin
(g/L)
>3528-35 <28
INR<1.71.7-2.3>2.3
AscitesNoneMild
(responds to diuretics)
Severe
(refractory to diuretics)
 EncephalopathyNoneGrade I-IIGrade 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]

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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