King's College criteria (acetaminophen liver failure)
Identifies acetaminophen-induced acute liver failure needing transplant referral.
Inputs
Arterial pH below 7.30 after fluid resuscitation
INR above 6.5
Creatinine above 3.4 mg/dL
Grade III or IV hepatic encephalopathy
Worked calculation
Your values are highlighted.
- Rule
pH < 7.30, or INR > 6.5 + Cr > 3.4 + grade III–IV encephalopathy= Not met
When to use
- Acetaminophen-induced acute liver failure.
Pearls and pitfalls
- High specificity, modest sensitivity: refer early to a transplant center even if criteria are not met.
- Lactate above 3.5 (at 4 h) or 3.0 (at 12 h) after resuscitation is a common modification.
Why use
The classic transplant listing criteria.
Arterial pH < 7.30 after resuscitation, OR all of: INR > 6.5, creatinine > 3.4 mg/dL, grade III–IV encephalopathy