Acute Liver Failure Study Group Index (ALFSG Index)

The index calculates a probability score (0.0 to 1.0) of transplant-free survival. A lower probability signifies a greater need for transplant.

In acetaminophen overdose, the INR rises first. A rising bilirubin *after* the INR has peaked is a marker of severe, potentially irreversible injury.

Any patient with ALF and a low recovery probability should be managed in a specialized liver transplant center with Status 1A priority listing.

N-acetylcysteine (NAC) has shown survival benefit in non-APAP ALF patients with early-stage (Grade I-II) encephalopathy.

Founded in 1997 by Professor William M. Lee. It is a network of 23 top US liver centers dedicated to studying this rare but critical condition.

For decades, the London-based King's College Criteria were the global standard. The ALFSG Index was the first major update to incorporate the unique North American etiology mix (e.g., higher APAP rates).