title: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States.
abstract: BACKGROUND
  Because acute liver failure is rare, related data have been sparse. Studies have suggested that viral hepatitis is the most common underlying cause of this condition.
  
  
  OBJECTIVE
  To describe the clinical features, presumed causes, and short-term outcomes of acute liver failure.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  17 tertiary care centers participating in the U.S. Acute Liver Failure Study Group.
  
  
  METHODS
  308 consecutive patients with acute liver failure, admitted over a 41-month period.
  
  
  METHODS
  Detailed clinical and laboratory data collected during hospitalization, including outcome 3 weeks after study admission.
  
  
  RESULTS
  73% of patients were women; median age was 38 years. Acetaminophen overdose was the most common apparent cause of acute liver failure, accounting for 39% of cases. Idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent of patients had liver transplantation, and 43% survived without transplantation. Short-term transplant-free survival varied greatly, from 68% for patients with acetaminophen-related liver failure to 25% and 17% for those with other drug reactions and liver failure of indeterminate cause, respectively. Coma grade at admission appeared to be associated with outcome, but age and symptom duration did not.
  
  
  CONCLUSIONS
  Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as the most frequent apparent causes of acute liver failure. Apparent cause and coma grade at admission were associated with outcome. Although transplantation may improve patient survival, it was unavailable or unnecessary for most patients.
authors.affiliation: Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Ostapowicz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Frank V
authors.initials: FV
authors.lastname: Schiødt
authors.forename: Anne
authors.initials: A
authors.lastname: Larson
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davern
authors.forename: Steven H B
authors.initials: SH
authors.lastname: Han
authors.forename: Timothy M
authors.initials: TM
authors.lastname: McCashland
authors.forename: A Obaid
authors.initials: AO
authors.lastname: Shakil
authors.forename: J Eileen
authors.initials: JE
authors.lastname: Hay
authors.forename: Linda
authors.initials: L
authors.lastname: Hynan
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Crippin
authors.forename: Andres T
authors.initials: AT
authors.lastname: Blei
authors.forename: Grace
authors.initials: G
authors.lastname: Samuel
authors.forename: Joan
authors.initials: J
authors.lastname: Reisch
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D062787:Drug Overdose / Q000150:complications; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006506:Hepatitis A / Q000150:complications; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D014481:United States
chemical_list: D000082:Acetaminophen