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:
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:
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Look closely at the jaundice cut-off: is the real criterion shorter or longer than a week?
Updated On: Jun 23, 2026
- Age
- Jaundice for <7 days
- Serum bilirubin >17.5 mg/dl
- INR >3.5
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The Correct Option is B
Solution and Explanation
Step 1: The King's College Criteria predict poor outcome in acute liver failure and the need for liver transplantation. They split into a paracetamol (APAP) arm and a non-paracetamol arm.
Step 2: For non-paracetamol causes, transplant is indicated if INR >6.5, OR any three of: age <10 or >40 years, cause being non-A non-B hepatitis or idiosyncratic drug reaction, duration of jaundice before encephalopathy >7 days, INR >3.5, and serum bilirubin >17.5 mg/dl.
Step 3: The criterion is jaundice for MORE than 7 days before encephalopathy, not less than 7 days. So jaundice <7 days is the odd one out and is the correct answer to this 'except' question.
Why the others fit: Age, INR >3.5, and bilirubin >17.5 mg/dl are all genuine variables in the criteria.
Ref: Harrison's Principles of Internal Medicine.
Step 2: For non-paracetamol causes, transplant is indicated if INR >6.5, OR any three of: age <10 or >40 years, cause being non-A non-B hepatitis or idiosyncratic drug reaction, duration of jaundice before encephalopathy >7 days, INR >3.5, and serum bilirubin >17.5 mg/dl.
Step 3: The criterion is jaundice for MORE than 7 days before encephalopathy, not less than 7 days. So jaundice <7 days is the odd one out and is the correct answer to this 'except' question.
Why the others fit: Age, INR >3.5, and bilirubin >17.5 mg/dl are all genuine variables in the criteria.
Ref: Harrison's Principles of Internal Medicine.
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