title: Etiologies and outcomes of acute liver failure in Germany.
abstract: OBJECTIVE
  Acute liver failure (ALF) is a severe form of acute liver injury that can progress to multiple organ failure. We investigated causes and outcomes of ALF.
  
  
  METHODS
  Eleven university medical centers in Germany were asked to report patients with (primary) severe acute liver injury (sALI) (international normalized ratio [INR] >1.5 but no hepatic encephalopathy) and primary ALF (INR >1.5 with overt hepatic encephalopathy) treated from 2008 to 2009. Data were analyzed from 46 patients with sALI and 109 patients with ALF.
  
  
  RESULTS
  The most frequent etiologies of primary ALF were non-acetaminophen drug-induced (32%), indeterminate (24%), and viral (21%); acetaminophen ingestion was the cause of ALF in only 9% of patients. The support of a ventilator was required by 44% of patients with ALF, vasopressors by 38%, and renal replacement by 36%. Seventy-nine patients with ALF (72%) survived until hospital discharge, 38 (35%) survived without emergency liver transplantation (ELT), and 51 received ELT (47%); 80% of patients who received ELT survived until discharge from the hospital.
  
  
  CONCLUSIONS
  In Germany, drug toxicity, indeterminate etiology, and viral hepatitis appear to be the major causes of primary ALF, which has high mortality. Patients with ALF are at great risk of progressing to multiple organ failure, but 80% of patients who receive ELT survive until discharge from the hospital.
authors.affiliation: Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany. hadem.johannes@mh-hannover.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Hadem
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.forename: Tony
authors.initials: T
authors.lastname: Bruns
authors.forename: Julia
authors.initials: J
authors.lastname: Langgartner
authors.forename: Pavel
authors.initials: P
authors.lastname: Strnad
authors.forename: Gerald U
authors.initials: GU
authors.lastname: Denk
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Fikatas
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Wolf P
authors.initials: WP
authors.lastname: Hofmann
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Frank
authors.initials: F
authors.lastname: Grünhage
authors.forename: Andreas
authors.initials: A
authors.lastname: Umgelter
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology*; D016019:Survival Analysis; D016896:Treatment Outcome