Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States.
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.
Ostapowicz
George
G
Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
Fontana
Robert J
RJ
Schiødt
Frank V
FV
Larson
Anne
A
Davern
Timothy J
TJ
Han
Steven H B
SH
McCashland
Timothy M
TM
Shakil
A Obaid
AO
Hay
J Eileen
JE
Hynan
Linda
L
Crippin
Jeffrey S
JS
Blei
Andres T
AT
Samuel
Grace
G
Reisch
Joan
J
Lee
William M
WM
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
D000082:Acetaminophen