cliot (version 1.0.0)

kings_college_criteria_acetaminophen: King's College Criteria for Acetaminophen Toxicity

Description

Calculates the King's College Criteria (KCC) for predicting poor prognosis in patients with Acetaminophen (Paracetamol) induced acute liver failure. Meeting the criteria indicates a high risk of mortality without liver transplantation.

Usage

kings_college_criteria_acetaminophen(arterial_ph, inr, creatinine,
                                     encephalopathy_grade,
                                     creatinine_units = "mg/dL")

Value

A list containing:

Result

Indication of whether the criteria for poor prognosis are met.

Recommendation

Clinical guidance regarding transplant referral.

Criteria_Fulfilled

Specific conditions that triggered the positive result.

Arguments

arterial_ph

Numeric. Arterial blood pH.

inr

Numeric. International Normalized Ratio.

creatinine

Numeric. Serum Creatinine level.

encephalopathy_grade

Numeric (0-4). Grade of hepatic encephalopathy (West Haven Criteria). 0: None. 1: Mild confusion/agitation. 2: Lethargy, disorientation. 3: Somnolence to semi-stupor, responsive to stimuli. 4: Coma.

creatinine_units

String. Units for creatinine input. Options: "mg/dL" (default) or "micromol/L" (or "umol/L").

Details

Criteria for Liver Transplantation are met if: 1. Arterial pH < 7.3 (irrespective of grade of encephalopathy). OR 2. All three of the following occur within a 24-hour period: - INR > 6.5 (PT > 100 seconds) - Serum Creatinine > 3.4 mg/dL (300 µmol/L) - Grade III or IV Encephalopathy

References

O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439-445. doi:10.1016/0016-5085(89)90081-4

Examples

# Example 1: Criteria Met (Acidosis)
# pH 7.1, INR 2.0, Cr 1.0, Grade 1 Enceph
kings_college_criteria_acetaminophen(7.1, 2.0, 1.0, 1)

# Example 2: Criteria Met (Triad)
# pH 7.35, INR 7.0, Cr 4.0, Grade 3 Enceph
kings_college_criteria_acetaminophen(7.35, 7.0, 4.0, 3)

# Example 3: Criteria Not Met
# pH 7.35, INR 5.0, Cr 2.0, Grade 2 Enceph
kings_college_criteria_acetaminophen(7.35, 5.0, 2.0, 2)