Hepatology · ICU and Critical Care

King's College Criteria for Acute Liver Failure calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Acute liver failure etiology branch

Select the etiology first. Acetaminophen branch: arterial pH <7.30 after resuscitation, or all of INR >6.5, creatinine >300 µmol/L, and grade III–IV encephalopathy. Non-acetaminophen branch: INR >6.5, or any three of age <10 or >40 years, unfavorable etiology, jaundice-to-encephalopathy interval >7 days, INR >3.5, and bilirubin >300 µmol/L.

Arterial pH after adequate fluid resuscitation

Allowed range: 6.5–8 pH

International normalized ratio

ratio

Allowed range: 0–20 ratio

Serum creatinine

mg/dL

Allowed range: 0–33.94 mg/dL

Hepatic encephalopathy grade

Age

years

Allowed range: 0–120 years

Non-A/non-B hepatitis, halothane hepatitis, or idiosyncratic drug reaction

Interval from jaundice onset to encephalopathy

days

Allowed range: 0–365 days

Serum bilirubin

mg/dL

Allowed range: 0–175.44 mg/dL

Result

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Clinical inputs

Acute liver failure etiology branch
Arterial pH after adequate fluid resuscitationAccepted range: 6.5 to 8
International normalized ratioAccepted range: 0 to 20
Serum creatinine (µmol/L)Accepted range: 0 to 3000
Hepatic encephalopathy grade
Age (years)Accepted range: 0 to 120
Non-A/non-B hepatitis, halothane hepatitis, or idiosyncratic drug reaction
Interval from jaundice onset to encephalopathy (days)Accepted range: 0 to 365
Serum bilirubin (µmol/L)Accepted range: 0 to 3000

Primary source

O'Grady JG et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. DOI: 10.1016/0016-5085(89)90081-4. PMID: 2490426. Scope: acute liver failure; acetaminophen and non-acetaminophen etiologies use distinct explicit branches. (1989)

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