King's College criteria (non-acetaminophen ALF)
Checks the non-acetaminophen arm of the King's College criteria for acute liver failure.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- INR
- 4
- Age
- 52 years
- Cause of the liver failure
- Non-A non-B (indeterminate or seronegative) hepatitis
- Days from the onset of jaundice to encephalopathy
- 10
- Total bilirubin
- 12
- Bilirubin unit
- mg/dl
Result: the second limb met on four of the five factors
The tool opens with these values already filled in. Replace them with your own.
What the result means
- First limb
- An INR above 6.5, or a prothrombin time above 100 seconds, on its own and whatever the grade of encephalopathy.
- Second limb
- Any three of five: age under 10 or over 40; non-A non-B, halothane or idiosyncratic drug cause; over 7 days from jaundice to encephalopathy; INR above 3.5; bilirubin above 17.5 mg/dL.
- Not the other arm
- The acetaminophen arm is a different set of variables, turning on arterial pH, creatinine and encephalopathy grade.
- A negative result
- Not reassurance. The criteria are specific and not sensitive, and a large share of the patients who go on to die never meet them.
- What it is for
- A reason to refer to a transplant center, not a decision to transplant. Referral does not wait on the criteria.
What you enter
- INR
- Prothrombin time, if the INR is not available
- Age
- Cause of the liver failure
- Days from the onset of jaundice to encephalopathy
- Total bilirubin
- Bilirubin unit
How this is calculated
O'Grady JG, Alexander GJM, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439-445. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.