page_title: King's College Criteria
section_title: Non-paracetamol acute liver failure
hierarchical_section_title: King's College Criteria / Criteria / Non-paracetamol acute liver failure
caption_attribution_description: English: Amanita phalloides. Piacenza's mountains
context_page_description: The King's College Criteria or the King's College Hospital criteria were devised in 1989 to determine if there were any early indices of poor prognosis in patients with acute liver failure. Acute liver failure is defined as the onset of encephalopathy or coagulopathy within 26 weeks of a patient diagnosed with liver disease. Patients with hepatitis B acquired at birth, Wilson's disease and autoimmune hepatitis are included if their disease was identified within the past 26 weeks. These patients are very ill, and have a very high risk of dying of their illness without adequate treatment which may include liver transplantation. It is important that physicians find ways of identifying patients with acute liver failure early in their course who will do poorly, and may require liver transplantation. The King's College Criteria have consistently shown excellent operating characteristics for determining prognosis in these patients. As liver transplantation becomes a more accessible option for patients with acute liver failure, the King's College Criteria serve a role in determining which patients may require transplantation.
context_section_description: There are many causes of acute liver failure aside from acetaminophen toxicity; these include viral hepatitis—including hepatitis A (rarely), hepatitis B, hepatitis C (rarely), hepatitis E (especially in pregnant women),  Epstein–Barr virus, cytomegalovirus and varicella zoster virus  -- Wilson's disease, the toxin of the death cap mushroom (Amanita phalloides), alcohol, autoimmune hepatitis, Budd–Chiari syndrome, other medications (including halothane, hormonal contraception, and isoniazid), recreational drugs (including ecstasy) and, rarely, tumours infiltrating the liver.
  In patients with non-acetaminophen acute liver failure, the following criteria were identified as being associated with a poor prognosis:
  INR greater than 6.5; or,
  Three of the following five criteria:
  Patient age of less than 11 or greater than 40;
  Serum bilirubin of greater than 300 micromoles per litre;
  Time from onset of jaundice to the development of coma of greater than seven days;
  INR greater than 3.5; or,
  Drug toxicity, regardless of whether it was the cause of the acute liver failure.
caption: Amanita phalloides, the death cap mushroom, is a cause of acute liver failure
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