title: Acute liver failure in a metropolitan area in Germany: a retrospective study (2002 - 2008).
abstract: OBJECTIVE
  To determine current etiologies of acute liver failure (ALF) and clinical and laboratory parameters associated with the outcome upon ALF, so as to identify the frequency of present causes of ALF in Germany as well as potential new prognostic parameters.
  
  
  METHODS
  134 adult patients (63 % females / 37 % males) aged 41 +/- 16 years (median: 38 years) with established ALF criteria.
  
  
  METHODS
  A retrospective study (1 / 2002 - 4 / 2008) on ALF patients from the Ruhr Area, the largest urban region located in northwestern Germany. Clinical and laboratory data were collected for a period of four weeks after study admission.
  
  
  RESULTS
  Etiologies of ALF were identified as drug toxicity (39.6 % of the cases); combined viral hepatitides (23.1 %); or miscellaneous (16.4 %). In 20.9 % of the cases, the etiology remained indeterminate. Overall patient survival at four weeks was 81.3 %. While 89 patients (66.4 %) recovered under best supportive therapy, 26 patients (19.4 %) had to undergo liver transplantation. Increased body mass indices were significantly (p < 0.003) associated with a poor outcome. Intriguingly, high levels of cholestatic enzymes significantly (p < 0.01) correlated with a positive outcome.
  
  
  CONCLUSIONS
  In providing first data on current ALF etiologies Germany, this study reveals that drug toxicity - in particular due to acetaminophen - has replaced viral hepatitis as the most single frequent cause of ALF in a densely populated urban area; this correlates with similar findings in the USA, the UK and Scandinavia. Lower body mass indices and elevated cholestatic enzyme levels had statistically significant prognostic power.
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Essen, Essen. ali.canbay@uni-essen.de
authors.forename: A
authors.initials: A
authors.lastname: Canbay
authors.forename: C
authors.initials: C
authors.lastname: Jochum
authors.forename: L P
authors.initials: LP
authors.lastname: Bechmann
authors.forename: S
authors.initials: S
authors.lastname: Festag
authors.forename: R K
authors.initials: RK
authors.lastname: Gieseler
authors.forename: Z
authors.initials: Z
authors.lastname: Yüksel
authors.forename: P
authors.initials: P
authors.lastname: Lütkes
authors.forename: F H
authors.initials: FH
authors.lastname: Saner
authors.forename: A
authors.initials: A
authors.lastname: Paul
authors.forename: G
authors.initials: G
authors.lastname: Gerken
mesh_terms: D000328:Adult; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005858:Germany; D006505:Hepatitis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014505:Urban Population / Q000706:statistics & numerical data*