title: Changing etiologies and outcomes of acute liver failure: perspectives from 6 transplant centers in Argentina.
abstract: There is significant geographic variation in the etiologies and prognoses of acute liver failure (ALF). The aims of the present study were to determine the causes and short-term outcomes of ALF in Argentina, to evaluate the performance of prognostic criteria, and to identify clinical prognostic factors of death. We performed a retrospective analysis of 154 adult patients with ALF who were admitted to 6 liver transplantation (LT) programs between June 2005 and December 2011. The most frequent causes of ALF were viral hepatitis B (46 patients or 30%), autoimmune hepatitis (AIH; 40 patients or 26%), and indeterminate causes (40 patients or 26%). No acetaminophen (ACM) overdose was reported. One hundred and twenty one patients (78%) were included on the waiting list, and LT was performed for 83 patients (54%). Overall survival rate is now corected to 73%. Multivariate logistic regression identified 2 independent variables associated with adverse outcomes on admission: a Model for End-Stage Liver Disease (MELD) score ≥ 29 and an encephalopathy grade ≥ 3. In a direct comparison using a receiving operating characteristic curve analysis, the MELD score [C statistic = 0.830, 95% confidence interval (CI) = 0.73-0.93] had better prognostic accuracy for predicting outcomes than the Clichy criteria (C statistic = 0.719, 95% CI = 0.58-0.85) or the King's College criteria (C statistic = 0.631, 95% CI = 0.49-0.77). In conclusion, hepatitis B and AIH were the most frequent causes of fulminant hepatic failure in our series, and no cases of ACM overdosing were identified. A MELD score ≥ 29 and an encephalopathy grade ≥ 3 at admission were associated with death. The MELD score at admission showed the highest prognostic accuracy.
authors.affiliation: Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.forename: Sebastián
authors.initials: S
authors.lastname: Marciano
authors.forename: María G
authors.initials: MG
authors.lastname: Videla
authors.forename: Margarita
authors.initials: M
authors.lastname: Anders
authors.forename: Alina
authors.initials: A
authors.lastname: Zerega
authors.forename: Domingo C
authors.initials: DC
authors.lastname: Balderramo
authors.forename: Débora
authors.initials: D
authors.lastname: Chan
authors.forename: Martín
authors.initials: M
authors.lastname: Barrabino
authors.forename: Octavio
authors.initials: O
authors.lastname: Gil
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mastai
authors.forename: Silvina
authors.initials: S
authors.lastname: Yantorno
authors.forename: Adrián
authors.initials: A
authors.lastname: Gadano
authors.forename: Marcelo O
authors.initials: MO
authors.lastname: Silva
mesh_terms: D000328:Adult; D001118:Argentina; D005260:Female; D006509:Hepatitis B / Q000601:surgery; D019693:Hepatitis, Autoimmune / Q000601:surgery; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome