Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure

McPhail, Mark; Wendon, Julia; Bernal, William

doi:10.1016/j.jhep.2010.03.023

Cited by 136 publications

(95 citation statements)

References 55 publications

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“…8 The King's College criteria are most commonly used to prioritise patients with paracetamol and idiosyncratic DILI for liver transplant. 53,54 Two earlier randomised controlled trials (RCTs) showed no benefit of corticosteroids in ALF and even demonstrated a poorer outcome in those with DILI. 55,56 A more recent study from the ALFSG corroborated this, showing no improvement in overall survival in drug-induced, indeterminate or autoimmune ALF (61% versus 66%, p=0.41).…”

Section: Acute Liver Failurementioning

confidence: 99%

Drug-induced liver injury

2016

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Drug-induced liver injury (DILI) remains the most common cause of acute liver failure (ALF) in the western world. Excluding paracetamol overdose, nearly all DILI encountered in the clinical setting is idiosyncratic in nature because affected individuals represent only a small proportion of those treated with such drugs. In many cases, the mechanism for idiosyncrasy is immune-mediation and is often identifi ed by genetic risk determined by human leukocyte antigen variants. In the absence of diagnostic tests and/or biomarkers, the diagnosis of DILI requires a high index of suspicion after diligently excluding other causes of abnormal liver tests. Antibiotics are the class of drugs most frequently associated with idiosyncratic DILI, although recent studies indicate that herbal and dietary supplements are an increasingly recognised cause. It is imperative that upon development of DILI the culprit drug be discontinued, especially in the presence of elevated transaminases (aspartate aminotransferase/alanine aminotransferase ratio ≥5 times the upper limit of normal) and/or jaundice. Risk factors for the development ALF include hepatocellular DILI and female gender, the treatment being supportive with some benefi t of N-acetylcysteine in the early stages. In view of the poor transplant-free survival in idiosyncratic DILI, early consideration for liver transplant is mandatory. KEYWORDS : Autoimmune hepatitis , cholestasis , drug-induced acute liver failure , herbal and dietary supplements , hepatocellular DILI , hepatotoxicity IntroductionAt a regulatory level, drug-induced liver injury (DILI) is the commonest reason for withdrawing drugs from the market and/or issuing warnings and modification of use.1 DILI is classified as either predictable or unpredictable (idiosyncratic). 2The former tends to be dose-related, has a short latency (days), is due to direct toxicity of the drug or its metabolite, and is ABSTRACT Drug-induced liver injuryreproducible in animal models (eg paracetamol overdose). 3The vast majority of DILI, however, is idiosyncratic or unpredictable -it is unexpected based on the pharmacological actions of the drug and in most cases routine animal toxicology fails to identify the risk of subsequent clinical toxicity. 4 This review shall largely focus on idiosyncratic DILI .

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Section: Acute Liver Failurementioning

confidence: 99%

Drug-induced liver injury

2016

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“…A later study updated this meta-analysis for AALF to include a further five studies, and found that the KCC had high diagnostic accuracy 24 . However given previous reports have found the KCC to be superior in AALF than in the subset with Non-Acetaminophen-induced ALF (NAALF), 25 a later meta-analysis assessed the KCC in NAALF, again finding that the KCC have high overall accuracy and in particular good specificity if more limited sensitivity 26 .…”

Section: Introductionmentioning

confidence: 99%

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

McPhail

Farne

Senvar

et al. 2016

Clinical Gastroenterology and Hepatology

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123

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“…Meta-analysis evaluated the survival among patients with ALF that was not induced by paracetamol showed moderate sensitivity (70%, 95% CI 61-79%) and higher specificity (80%, 95% CI 73-87%), in which the capacity to discriminate between the need for transplant and the lack to need were evaluated by ROC curve, with Q of 0.783 7 . Another meta-analysis performed to evaluate King's College criterion among patients with ALF, secondary to paracetamol, revealed sensitivity of 69% and specificity of 92%, but Q was 0.61 18 .…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic evaluation criterion mostly used for this is King's College 6 . Meta-analysis studies have confirmed its specificity (80%), but reported limited sensitivity (70%) 7 . To overcome this limitation, other prognostic criteria might be used, such as Clichy´s criteria, which takes into consideration the alterations of factor V coagulation, the patient's age and the presence of encephalopathy 8 .…”

Section: Introductionmentioning

confidence: 98%

Evaluating the best time to intervene acute liver failure in rat models induced by d-galactosamine

et al. 2016

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PURPOSE:To describe an animal model for acute liver failure by intraperitoneal d-galactosamine injections in rats and to define when is the best time to intervene through King's College and Clichy´s criteria evaluation. METHODS:Sixty-one Wistar female rats were distributed into three groups: group 1 (11 rats received 1.4 g/kg of d-galactosamine intraperitoneally and were observed until they died); group 2 (44 rats received a dose of 1.4 g/kg of d-galactosamine and blood and histological samples were collected for analysis at 12 , 24, 48 , 72 and 120 hours after the injection); and the control group as well (6 rats). RESULTS:Twelve hours after applying d-galactosamine, AST/ALT, bilirubin, factor V, PT and INR were already altered. The peak was reached at 48 hours. INR > 6.5 was found 12 hours after the injection and factor V < 30% after 24 hours. All the laboratory variables presented statistical differences, except urea (p = 0.758). There were statistical differences among all the histological variables analyzed. CONCLUSION:King's College and Clichy´s criteria were fulfilled 12 hours after the d-galactosamine injection and this time may represent the best time to intervene in this acute liver failure animal model.

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Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure

Cited by 136 publications

References 55 publications

Drug-induced liver injury

Drug-induced liver injury

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

Evaluating the best time to intervene acute liver failure in rat models induced by d-galactosamine

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