While King's Hospital Criteria are used worldwide, the Model for End-Stage Liver Disease (MELD) is a more recently developed scoring system.
MELD has been validated as an independent predictor of patient survival in conditions for liver transplantation.
Dr Radha K. Dhiman and colleagues from India, USA compared MELD and King's Hospital Criteria with other early clinical prognostic indicators in patients with fulminant hepatic failure.
The team evaluated a total of 144 patients with fulminant hepatic failure due to acute viral hepatitis, and a mean age of 32 years.
Variables found significant on univariate analysis were entered into a multivariate logistic regression analysis.
|Cerebral edema was an independent prognostic indicator|
The team reported that a total of 52 patients survived.
The research team showed that age, duration of jaundice, and jaundice-encephalopathy interval were different between survivors and no survivors.
The team noted that grade of encephalopathy, cerebral edema, bilirubin, prothrombin time, creatinine, and MELD score were different between survivors and nonsurvivors.
Using multivariate logistic regression, the team identified 6 independent clinical prognostic indicators of adverse outcome on admission.
Age of 50 years, a jaundice-encephalopathy interval more than 7 days, and Grade 3 or 4 encephalopathy were 3 of these independent indicators.
Presence of cerebral edema, a prothrombin time of 35 seconds, and creatinine 1.5 mg/dL were the remaining 3 independent prognostic indicators.
The team observed that presence of any 3 of 6 clinical prognostic indicators was optimum in identifying survivors and nonsurvivors.
A MELD score of 33 was found to be best discriminant between survivors and nonsurvivors by the construction of receiver operating characteristic curves.
Any 3 clinical prognostic indicators were superior to MELD and King's Hospital Criteria in predicting the outcome.
Dr Dhiman's team concluded, "MELD and King's Hospital Criteria, criteria are not as useful as a combination of other early clinical prognostic indicators in predicting adverse outcome in patients with fulminant hepatic failure due to acute viral hepatitis."