ALF (Acute Liver Failure)
Acute liver failure (ALF) is a rare but devastating illness with a high risk of progression to multiorgan failure and death. Failure to identify those in need of emergency liver transplantation results in a potentially preventable death. Many medications can cause liver injuries. Among many drugs, acetaminophen is one of the most common drugs responsible for ALF. King’s College criteria are used to determine which patients would benefit from liver plantation for acute or fulminant liver failure.
King’s College Criteria
King’s College Criteria is used to determine which patients would benefit from liver transplantation after developing acute liver failure secondary to the use of acetaminophen. This criteria recommends who should be immediately referred for liver transplantation. This criteria can be applied to both acute and chronic acetaminophen ingestion. Among the various criteria used for evaluating patients with acetaminophen (Tylenol) toxicity, this criteria is widely accepted.
King’s College Criteria were derived from a retrospective analysis of 588 patients from the pretransplant era (1973–1985), and have subsequently been validated in many centers. There are two King’s College criteria: one for acetaminophen-induced ALF (AALF) and one for non-acetaminophen-induced ALF (NAALF). In a study done by O’Grandy in 1989, fulfillment of this criteria predicted 77% of total death in patients with acetaminophen-induced acute liver failure.
This criteria has very high specificity (93%). However, it has low sensitivity (65%) and a negative predictive value for a poor outcome, i.e., fulfillment of the criteria causes a poor prognosis, but lack of fulfillment may still carry an unfavorable outlook.
The King’s College criteria for acetaminophen-induced ALF are shown in the picture below.
The easy mnemonic to remember the components and cut off values of the parameters used in the criteria are shown in the picture below.
The video about the King’s College Criteria for Acetaminophen-induced ALF is embedded below from our YouTube channel, Extensive Medicine.
MBBS, MD (Internal Medicine)
