How can I assess the severity of acute liver failure in a patient before making a referral?

To assess the severity of acute liver failure before making a referral, focus on clinical signs of decompensated liver disease such as jaundice, ascites, hepatic encephalopathy, and gastrointestinal haemorrhage, which indicate severe illness requiring urgent specialist input. Immediate referral to a hepatologist or gastroenterologist with an interest in hepatology is recommended if these symptoms are present. Additionally, laboratory tests including prothrombin time, bilirubin, liver enzymes (ALT, AST), serum albumin, and full blood count should be arranged to evaluate liver function and synthetic capacity. Clinical judgement should integrate these findings with the patient's overall condition, as mortality risk scores may not always fully capture severity. For example, a patient with a low mortality risk score but with significant clinical deterioration should be considered severely ill and referred promptly.