Acute liver failure.
Acute liver failure is a rare disorder with high mortality and resource cost. In the developing world, viral causes predominate, with hepatitis E infection recognised as a common cause in many countries. In the USA and much of western Europe, the incidence of virally induced disease has declined substantially in the past few years, with most cases now arising from drug-induced liver injury, often from paracetamol. However, a large proportion of cases are of unknown origin. Acute liver failure can be associated with rapidly progressive multiorgan failure and devastating complications; however, outcomes have been improved by use of emergency liver transplantation. An evidence base for practice is emerging for supportive care, and a better understanding of the pathophysiology of the disorder, especially in relation to hepatic encephalopathy, will probably soon lead to further improvements in survival rates.
Bernal
William
W
Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, London, UK. william.bernal@kcl.ac.uk
Auzinger
Georg
G
Dhawan
Anil
A
Wendon
Julia
J
D000082:Acetaminophen / Q000009:adverse effects*; D000641:Ammonia / Q000378:metabolism*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D004638:Emergency Treatment / Q000379:methods; D005060:Europe / Q000453:epidemiology; D014943:Global Health; D006501:Hepatic Encephalopathy / Q000453:epidemiology / Q000209:etiology; D006525:Hepatitis, Viral, Human / Q000150:complications*; D022781:Hepatocytes / Q000637:transplantation; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000145:classification / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D018579:Patient Selection; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D000641:Ammonia