Comparison of King's College Hospital Criteria (KCH) with Model for End-Stage Liver Disease (MELD) for Predicting Outcome in Patients with Acute Liver Failure

Objective: To compare the Model for End-Stage Liver Disease (MELD) and The King's College Hospital Criteria (KCH) as early clinical prognostic indicators in patients with Acute Liver Failure. Methodology: This descriptive Case series study was conducted in emergency medical wards of Liaquat University Hospital Jamshoro and Hyderabad from February 2008 to July 2010. This study included 76 consecutive patients with ALF defined as onset of hepatic encephalopathy occurring within 12 weeks of onset of jaundice. The patients using sedatives, anticoagulants or if any evidence of chronic liver disease were excluded. Laboratory workup was done from laboratory of University. MELD score of >= 33 and presence of positive criteria for KCH category were taken as a bad prognostic indicator. The primary end point was death during hospital stay. Continuous variables were computed as mean +/- standard deviation (SD) and categorical variables as frequency and percentage. Results: Out of 76 patients 49 were male (64.47%) and 27 (35.53%) female. The mean age of patients was 24.62 +/- 10.3. Out of 76 patients a total of 59 patients (77.63%) died during the study period. The KCH criteria cut off point was reached in a total of 63 patients (out of 76) of which 50 patients died. The MELD criteria cutoff point (MELD Score > 33) was reached in 49 patients (out of 76) of which 46 eventually died.KCH predicted outcome with the sensitivity of 80% and Positive predictive value (PPV) of 89% (p=0.001). MELD predicted outcome with sensitivity of 82.4% and Positive predictive value (PPV) of 94%(p=0.001).Viral hepatitis B was the most common cause of Acute Liver Failure. Conclusion: Both criteria are good predictors of the outcome in acute liver failure.