Table 4.

Prognostic Scoring Systems Used to Identify Patients at High Risk of Mortality Without Liver Transplantation Due to APAP‐Related ALF

Scoring System	Key Components	Sensitivity	Specificity
King's College criteria	Arterial pH < 7.30	55%	93%
	or
	Prothrombin time > 100 plus	58%	95%
	Encephalopathy grade > 2 plus
	Serum creatinine > 3.4 mg/dl
Arterial lactate	3.5 mmol/l on presentation	81%	72%
	or
	> 3 mmol/l after fluid resuscitation	81%	77%
Modified King's College criteria	King College criteria plus arterial lactate > 3 mmol/l following resuscitation	91%	71%
APACHE II	Score > 15 at 24‐hour postadmission	79%	97%
SOFA score	Score > 8 at admission	67%	66%
MELD score	MELD > 30	97%	68%
ALFSG index	Coma grade, bilirubin, INR, serum phosphate, M‐30 (serum marker of apoptosis)	86%	65%
Routinely used indicators of poor prognosis	Arterial pH < 7.3	Presence of 2 or more factors associated with poor transplant‐free survival
	Arterial lactate > 3 mmol/l following resuscitation
	Encephalopathy grade III or IV
	Factor V ratio < 20%

Sensitivities and specificities stated for transplant‐free survival.

Abbreviations: ALFSG, Acute Liver Failure Study Group; MELD, Model for End‐Stage Liver Disease; SOFA, Sequential Organ Failure Assessment.