title: Causes and outcomes of acute liver failure in China.
abstract: OBJECTIVE
  No extensive investigation has been performed and thus no representative data are available regarding acute liver failure (ALF) in China. This study aims to investigate the causes and outcomes of ALF in China and establish a prognostic model.
  
  
  METHODS
  Patients diagnosed as ALF in seven hospitals in different areas of China from January 2007 to December 2012 were retrospectively selected.
  
  
  RESULTS
  Of the 177 patients included in this study, 112 (63.28%) eventually died. The common causes of ALF were drug toxicity (43.50%), indeterminate etiology (29.38%) and acute viral hepatitis (11.30%). Additionally, traditional Chinese herbs predominated in the causes of drug-induced ALF (30/77). No patients in this study received liver transplantation. In the established model for predicting death in ALF, four variables were finally selected out, including age (P=0.01), the entry hepatic encephalopathy grade (P=0.04), international normalized ratio (P<0.01) and arterial blood ammonia (P=0.02). Using a threshold value of 0.5683, this model had a sensitivity of 95.24% and a specificity of 91.30%.
  
  
  CONCLUSIONS
  Traditional Chinese medicine was a major cause of ALF in China. The spontaneous mortality of ALF was high, whereas the rate of liver transplantation was significantly low. The established prognostic model of ALF had superior sensitivity and specificity.
authors.affiliation: Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China.
authors.forename: Pan
authors.initials: P
authors.lastname: Zhao
authors.forename: Chunya
authors.initials: C
authors.lastname: Wang
authors.forename: Weiwei
authors.initials: W
authors.lastname: Liu
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Xinying
authors.initials: X
authors.lastname: Liu
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
authors.forename: Bao
authors.initials: B
authors.lastname: Wang
authors.forename: Liming
authors.initials: L
authors.lastname: Yu
authors.forename: Yanrong
authors.initials: Y
authors.lastname: Sun
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Liang
authors.forename: Haozhen
authors.initials: H
authors.lastname: Yang
authors.forename: Fei
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012372:ROC Curve; D055815:Young Adult