King's College criteria

The King's College criteria identify patients with acute liver failure who are unlikely to survive without emergency liver transplant. Tick the features present. Discuss any patient with acute liver failure early with a transplant unit, whether or not the criteria are met.

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Notes

• The criteria are specific but not very sensitive: many patients who do not meet them still die without transplant.
• For paracetamol, the lactate criterion (modified criteria) identifies poor prognosis earlier than the original criteria.
• Wilson disease and Budd-Chiari syndrome presenting as acute liver failure need specialist discussion regardless of the criteria.

References

O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439-445.

Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet. 2002;359(9306):558-563.