MDCalc » Hepatology

King’s College Criteria

admin — Thu, 18 Mar 2010 11:53:44 +0000

Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003 Jan;31(1):299-305.
Goldfrank's Toxicologic Emergencies, 8th Edition.
Treatment of hepatic encephalopathy. N Engl J Med. 1997 Aug 14;337(7):473-9.

Grade 1 - Inverted sleep pattern; forgetfulness, mild confusion, agitation, irritability, tremor, apraxia
Grade 2 - Lethargy, slow responses; Disorientation for time or place, Subtle personality change; Asterixis, dysarthria, ataxia
Grade 3 - Somnolence but rousability, Disorientation as regards place; Asterixis, hyperactive reflexes, Babinski signs, muscle rigidity
Grade 4 - Coma (unresponsive to verbal or noxious stimuli)

Glasgow-Blatchford Bleeding Score (GBS)

admin — Thu, 08 Oct 2009 03:34:18 +0000

Glasgow-Blatchford Score

Blood Urea
≥6·5 <8·0	2
≥8·0 <10·0	3
≥10·0 <25·0	4
≥25	6
Hemoglobin (g/L) for men
≥12.0 <13.0	1
≥10.0 <12.0	3
<10.0	6
Hemoglobin (g/L) for women
≥10.0 <12.0	1
<10.0	6
Systolic blood pressure (mm Hg)
100–109	1
90–99	2
<90	3
Pulse ≥100 (per min)	1
Presentation with melaena	1
Presentation with syncope	2
Hepatic disease	2
Cardiac failure	2

Low risk = Score of 0. Any score higher than 0 is "high risk" for needing a medical intervention of transfusion, endoscopy, or surgery.

A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Lancet 2000.

A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet, 2000.

A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Am J Emerg Med. 2007.

Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. The Lancet, 2009.

Child-Pugh Score for Cirrhosis Mortality

admin — Wed, 11 Feb 2009 14:15:18 +0000

Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). Transection of the oesophagus for bleeding oesophageal varices. The British journal of surgery 60 (8).

PELD Score (Pediatric End-Stage Liver Disease) (younger than 12)

admin — Fri, 02 Jan 2009 04:24:49 +0000

PELD Score = 10* (0.480 * ln(bilirubin) + 1.857 * ln(INR) - 0.687 * ln(albumin) + 0.436 (if pt < 1 year: scores for patients listed for liver transplantation before the patient's first birthday continue to include the value assigned for age (< 1 Year) until the patient reaches the age of 24 months) + 0.667 (if pt has growth failure of <-2 Standard deviation) )

UNOS PELD Calculator

MELD Score (Model For End-Stage Liver Disease) (12 and older)

admin — Fri, 02 Jan 2009 04:20:46 +0000

MELD Score = (0.957 * ln(Serum Cr) + 0.378 * ln(Serum Bilirubin) + 1.120 * ln(INR) + 0.643 ) * 10 (if hemodialysis, value for Creatinine is automatically set to 4.0)

UNOS MELD Calculator

Maddrey’s Discriminant Function for Alcoholic Hepatitis

admin — Fri, 02 Jan 2009 03:49:46 +0000

Discriminant Function = 4.6 * (Pt's PT - Control PT) + TBili

Calcium Correction for Hypoalbuminemia

admin — Fri, 02 Jan 2009 03:38:58 +0000

Corrected Calcium = (0.8 * (Normal Albumin - Pt's Albumin)) + Serum Ca

Lactate > 3.5 mg/dL (0.39 mmol/L) 4 hrs after early fluid resuscitation?	Yes
pH < 7.30 or lactate > 3 mg/dL (0.33 mmol/L) after full fluid resuscitation at 12 hours	Yes
INR > 6.5 (PTT > 100s)	Yes
Creatinine > 3.4 mg/dL (300 µmol/L)	Yes
Grade 3 or 4 Hepatic Encephalopathy?	Yes
Phosphorus > 3.75 mg/dL (1.2 mmol/L) at 48 hours	Yes

Is patient female?	Yes
Hemoglobin	g/dL
BUN	mg/dL
Initial Systolic Blood Pressure	mm Hg
Heart Rate ≥ 100	Yes
Does the patient have melena?	Yes
Did the patient have syncope?	Yes
Does the patient have hepatic disease?	Yes
Does the patient have heart failure?	Yes
Score	points

Total Bilirubin	<2 mg/dL (<34 µmol/L) +1 2-3 mg/dL (34-50 µmol/L) +2 >3 mg/dL (>50 µmol/L) +3
Albumin	>3.5 g/dL (>35 g/L) +1 2.8-3.5 g/dL (28-35 g/L) +2 <2.8 g/dL (<28 g/L) +3
INR	<1.7 +1 1.7-2.2 +2 >2.2 +3
Ascites	No Ascites +1 Ascites, Medically Controlled +2 Ascites, Poorly Controlled +3
Encephalopathy	No Encephalopathy +1 Encephalopathy, Medically Controlled +2 Encephalopathy, Poorly Controlled +3
Score	points

Age	years old
Serum Bilirubin	mg/dL
Albumin	g/dL
INR
Does the patient have growth failure (see page 3 of linked PDF)?	Yes
PELD Score

Serum Bilirubin	mg/dL
INR
Serum Creatinine	mg/dL
Has the patient had dialysis at least twice in the past week?	Yes
MELD Score	points

Pt's Prothrombin Time (PT)	sec
Lab Control Prothrombin Time (PT)	sec
Pt's Serum Total Bilirubin	mg/dL
Discriminant Function	points
>32 points indicates poor prognosis and pt may benefit from glucocorticoid therapy.

Serum Calcium	mg/dL
Normal Albumin	g/dL
Patient Albumin	g/dL
Corrected Calcium	mg/dL