title: Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome.
abstract: OBJECTIVE
  To describe incidence, aetiology and outcome data for Scotland since the inception of the Scottish Liver Transplant Unit (SLTU) in 1992.
  
  
  BACKGROUND
  Acute liver failure (ALF) is a rare but frequently fatal condition. Few studies have adequate patient numbers to draw convincing conclusions over demographic features, aetiology and outcome.
  
  
  METHODS
  Statistical analysis of prospectively collected data on aetiology, demographic, clinical and outcome of all admissions, including those with ALF, to the SLTU.
  
  
  METHODS
  Incidence data presented for admissions and ALF. Descriptive frequencies for aetiology, clinical, demographic and outcome data presented; including split analysis for paracetamol and non-paracetamol aetiologies. Univariate and multivariate analysis of admission factors predictive of outcome is described.
  
  
  RESULTS
  Nine hundred and forty-nine patients were admitted to the SLTU between 1992 and 2009. Five hundred and twenty-four patients had ALF. The annual incidence of ALF in the Scottish population is 0.62 per 100,000 and paracetamol overdose (POD) was the largest causative factor; responsible for 0.43 cases of ALF per 100,000 population per year. The odds ratio (OR) of transplantation or death was 0.47 in the POD group compared to other aetiologies; yet of not being a transplant candidate having met the Kings College Hospital poor prognostic criteria OR was 4.9. Of admissions listed for transplant 76.0% were transplanted. Of those listed and not transplanted mortality was approaching 100% and 76.1% of those transplanted survived to discharge.
  
  
  CONCLUSIONS
  This large, prospective, single centre study with a defined geographical area and well-recorded population provides accurate data regarding ALF between 1992 and 2009.
authors: Scottish Liver Transplant Unit, NHS, Lothian Universities Hospital Trust, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, UK. a.bretherick@nhs.net
authors: A D
authors: AD
authors: Bretherick
authors: D G N
authors: DG
authors: Craig
authors: G
authors: G
authors: Masterton
authors: C
authors: C
authors: Bates
authors: J
authors: J
authors: Davidson
authors: K
authors: K
authors: Martin
authors: J P
authors: JP
authors: Iredale
authors: K J
authors: KJ
authors: Simpson
mesh_terms: D000082:Acetaminophen / Q000506:poisoning; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000506:poisoning; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen