King’s College Criteria (acetaminophen-induced ALF)
King’s College Criteria for transplant referral in acetaminophen-induced acute liver failure: the arterial pH limb, the INR/creatinine/encephalopathy three-part limb, or the modified lactate limb.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- INR
- 7
- Creatinine
- 4.0
- Creatinine unit
- mg/dL (threshold > 3.4)
- Grade III/IV encephalopathy
- Yes
Result: Meets King’s College Criteria (acetaminophen pathway): three-part limb (INR > 6.5, creatinine > 3.4 mg/dL, grade III/IV encephalopathy).
The tool opens with these values already filled in. Replace them with your own.
What the result means
- pH limb
- Arterial pH < 7.30 after adequate fluid resuscitation → poor prognosis (refer/list for transplant).
- Three-part limb
- All of INR > 6.5 (PT > 100 s) + creatinine > 3.4 mg/dL (> 300 µmol/L) + grade III/IV encephalopathy → poor prognosis.
- Modified (lactate)
- Arterial lactate > 3.5 mmol/L early (or > 3.0 after resuscitation) → poor prognosis (Bernal).
What you enter
- Arterial pH (after resuscitation)
- Arterial lactate
- Lactate timing (required when lactate is provided)
- INR
- Prothrombin time
- Creatinine
- Creatinine unit (required when creatinine is provided)
- Grade III/IV encephalopathy
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. Lactate modification: Bernal W, et al. Lancet. 2002;359(9306):558-563. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.