title: Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis.
abstract: OBJECTIVE
  The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes.
  
  
  METHODS
  Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis.
  
  
  RESULTS
  Ischemic hepatitis accounted for 51 (4.4%) of the 1147 ALF patients enrolled. Mean age was 50 years, 63% were female, and only 31% had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69%. Three-week spontaneous survival was 71%, two patients (4%) underwent liver transplantation, and the remaining 13 patients (25%) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95% CI 1.1-1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95% CI 1.1-66.5, P = 0.04). Nineteen of the 28 short-term survivors (68%) were still alive at a median follow-up of 3.7 years whereas nine (32%) others had died at a median follow-up of 2 months.
  
  
  CONCLUSIONS
  A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.
authors.affiliation: Department of Internal Medicine, University of Kansas, Kansas City, KS, USA. rtaylor2@kumc.edu
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Taylor
authors.forename: Shannan
authors.initials: S
authors.lastname: Tujios
authors.forename: Kartik
authors.initials: K
authors.lastname: Jinjuvadia
authors.forename: Timothy
authors.initials: T
authors.lastname: Davern
authors.forename: Obaid S
authors.initials: OS
authors.lastname: Shaikh
authors.forename: Steve
authors.initials: S
authors.lastname: Han
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000097:blood / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000097:blood / Q000401:mortality; D006505:Hepatitis / Q000097:blood / Q000401:mortality*; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000401:mortality*; D017114:Liver Failure, Acute / Q000097:blood / Q000401:mortality*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality; D010710:Phosphates / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D010710:Phosphates