In patients with acute liver failure, the best prognostic indicator is:

Answer is D (Factor V estimation): It is difficult to choose one best prognostic factor as most criteria use a combination of various markers to assess the results. However amongst the options provided 'factor V' estimation should be the choice to pick. This is so because, coagulation factors have sho serum half lives and their levels thus best determines the current status of liver function. The severity of hepatic lesion and moality correlates best with the extent to which plasma levels of liver derived coagulation factors are depressed. Prothrombin time which collectively measures factors II, VII, IX and X has not beenprovided amongst the options. Levels of coagulation Factor V have also been shown to predict prognosis in patients with acute liver failure. Accordingly perhaps 'Clinchy (France)' has use :factor V levels' as an isolated prognostic marker in his criteria i.e. 'Clinchy criteria' Clinchy Criteria (France) Factor V levels < 20% of normal in patients < 30 years of age Factor V levels < 30% of normal in patients < 30 years of age NB: The above factors indicate poor prognosis. Coagulation factors as Laboratory Prognostic markers in patients with acute liver failure include the following: Prothrombin time (King's criteria) Factor V levels (Clinchy's criteria) INR (CMDT)