Question

All of the following are part of the King's College Criteria used in acute fulminant (non-paracetamol) liver failure to decide for transplantation, EXCEPT:

• A. Age
• B. Jaundice for <7 days
• C. Serum bilirubin >17.5 mg/dl
• D. INR >3.5

Hint:

Look closely at the jaundice cut-off: is the real criterion shorter or longer than a week?

Answer 1

The Correct Option is B

Quick mnemonic approach: the non-paracetamol King's College set asks for either a very high INR alone ($INR > 6.5$) or any THREE of five risk variables. Run the option list against those five variables. Age (extremes, <10 or >40 years) is a variable. INR $> 3.5$ is a variable. Bilirubin $> 17.5$ mg/dl is a variable. That leaves the jaundice item. The actual variable is duration of jaundice BEFORE encephalopathy being $> 7$ days, a marker of a slow, ominous course. The option printed here flips it to $< 7$ days, so it does not belong to the criteria and is the answer the stem is hunting for. Clinical pearl: longer jaundice-to-encephalopathy interval signals worse prognosis in non-paracetamol ALF, the opposite of the hyperacute paracetamol picture.