title: Novel classification of acute liver failure through clustering using a self-organizing map: usefulness for prediction of the outcome.
abstract: BACKGROUND
  Patients with acute liver failure are classified according to the interval between the onset of hepatitis symptoms and the development of hepatic encephalopathy. We examined the validity of such classifications.
  
  
  METHODS
  The subjects were 1,022 patients enrolled in a nationwide survey in Japan. The intervals between the onset of the hepatitis symptoms and the development of encephalopathy were 10 days or less in 472 patients (group-A), between 11 and 56 days in 468 patients (group-B), and longer than 56 days in 82 patients (group-C). Data on a total of 104 items collected from the patients were subjected to clustering using a self-organizing map.
  
  
  RESULTS
  The patients were classified into three clusters. The first cluster consisted of 411 patients (group-A: 57%, group-B: 39%, group-C: 4%). Their incidence of complications was low; 34% underwent liver transplantation (LT), and their survival rate was 90%, while 94% of those treated without transplant were rescued. The second cluster consisted of 320 patients (21, 65, and 14% groups A, B, and C, respectively), who showed a high incidence of complications; the survival rate was 7% in the patients treated conservatively without LT. Sixteen percent underwent LT and survival rate of these patients was 52%. There was a third cluster, of 291 patients (59, 34, and 7% groups A, B, and C, respectively). Without LT, 81% of the patients died. Seven percent were treated by LT and their survival rate was 60%.
  
  
  CONCLUSIONS
  Clustering revealed that patients with acute liver failure could be classified into three clusters independent of the interval between the onset of disease symptoms and the development of encephalopathy. This technique may be useful, since the outcomes of the patients differed markedly among the clusters.
authors: Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Morohongo 38, Moroyama-Machi, Iruma-Gun, Saitama 350-0495, Japan.
authors: Nobuaki
authors: N
authors: Nakayama
authors: Makoto
authors: M
authors: Oketani
authors: Yoshihiro
authors: Y
authors: Kawamura
authors: Mie
authors: M
authors: Inao
authors: Sumiko
authors: S
authors: Nagoshi
authors: Kenji
authors: K
authors: Fujiwara
authors: Hirohito
authors: H
authors: Tsubouchi
authors: Satoshi
authors: S
authors: Mochida
references: Hepatol Res. 2008 Jul;38(7):646-57
references: 18328067
references: FEBS Lett. 2004 Dec 3;578(1-2):10-20
references: 15581608
references: Hepatology. 1986 Mar-Apr;6(2):288-94
references: 3082735
references: Hepatol Res. 2008 Oct;38(10):970-9
references: 18462374
references: Neural Netw. 2009 Apr;22(3):200-12
references: 19386468
references: Dig Dis Sci. 1998 Jun;43(6):1311-6
references: 9635624
references: Int J Health Geogr. 2008 Dec 30;7:67
references: 19116020
references: Intern Med. 2001 Feb;40(2):175-7
references: 11300160
references: Transplantation. 2005 Jan 27;79(2):213-8
references: 15665770
references: Int J Oncol. 2005 Sep;27(3):661-7
references: 16077914
references: Ultrason Imaging. 1993 Jul;15(3):205-17
references: 8879092
references: Comput Methods Programs Biomed. 2009 Jun;94(3):223-31
references: 19215994
references: Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii5-viii8
references: 17890263
references: BMC Bioinformatics. 2006 Dec 18;7 Suppl 5:S22
references: 17254307
references: Comput Biol Chem. 2006 Jun;30(3):169-78
references: 16600687
references: Hepatology. 2005 May;41(5):1179-97
references: 15841455