ALFED Score Components
To calculate the ALFED (Acute Liver Failure Early Dynamic) score, you need five specific parameters measured at baseline and again at 48 hours: hepatic encephalopathy grade, INR, serum bilirubin, serum creatinine, and arterial lactate. 1
Required Clinical and Laboratory Parameters
The ALFED score is a dynamic prognostic model specifically designed for acute liver failure that requires serial measurements to assess disease trajectory 1:
Baseline Assessment (Day 0)
- Hepatic encephalopathy grade (West Haven criteria: 0-4) 1
- International Normalized Ratio (INR) 1
- Serum bilirubin (total bilirubin in mg/dL) 1
- Serum creatinine (in mg/dL) 1
- Arterial lactate (in mmol/L) 1
48-Hour Reassessment
- All five parameters must be repeated at 48 hours to calculate the dynamic change, which is the core principle of the ALFED scoring system 1
Key Distinguishing Features
The ALFED score demonstrated excellent specificity (84%) for predicting mortality in acute liver failure, with an optimal cutoff of ≥5 points being highly predictive of poor outcome. 1
Performance Characteristics
- The ALFED score showed an area under the ROC curve of 0.844, making it one of the most accurate prognostic tools for non-acetaminophen-induced acute liver failure 1
- At threshold probabilities >0.6, the ALFED score provides maximum clinical benefit compared to other scoring systems 1
- The dynamic nature (measuring change over 48 hours) makes it superior to static baseline measurements alone 1
Clinical Context and Timing
Serial measurement at 48 hours is essential—the ALFED score cannot be calculated with a single time point. 1 This dynamic assessment captures disease trajectory, which is why it outperforms static models in certain clinical scenarios 1.
Practical Considerations
- The score is most validated for non-acetaminophen-induced acute liver failure 1
- It should be calculated alongside SOFA scores at 48 hours, as SOFA 48 hours (with cutoff ≥10) showed the highest sensitivity (87%) and can complement ALFED's high specificity 1
- The combination of both scores provides comprehensive prognostic information across different threshold probabilities for clinical decision-making 1