title: Acute liver failure in Sweden: etiology and outcome.
abstract: OBJECTIVE
  To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome.
  
  
  METHODS
  Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included.
  
  
  RESULTS
  A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively.
  
  
  CONCLUSIONS
  Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.
authors: Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: G
authors: G
authors: Wei
authors: A
authors: A
authors: Bergquist
authors: U
authors: U
authors: Broomé
authors: S
authors: S
authors: Lindgren
authors: S
authors: S
authors: Wallerstedt
authors: S
authors: S
authors: Almer
authors: P
authors: P
authors: Sangfelt
authors: A
authors: A
authors: Danielsson
authors: H
authors: H
authors: Sandberg-Gertzén
authors: L
authors: L
authors: Lööf
authors: H
authors: H
authors: Prytz
authors: E
authors: E
authors: Björnsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology