[Drug-induced liver injury as predominant cause of acute liver failure in a monocenter study].
OBJECTIVE
Clinical course and mortality of acute liver failure (ALF) are determined by its causes. Traditionally, fulminant hepatitis B infection (HBV) was thought to be the predominant etiology of ALF in Germany. However, recent studies, conducted in American and European cohorts pointed to drug-induced liver injury (DILI) as the major cause. Aim of this study was to identify currently predominant etiologies of ALF in a monocenter study at a leading transplant center in Germany.


METHODS
The data of 161 patients admitted with ALF from 1/2002 to 12/2012 were analyzed retrospectively. All patients fulfilled the criteria of the "Acute Liver Failure Study Group Germany" (international normalized ratio (INR) ≥ 1.5, hepatic encephalopathy ≥ stage 1).


RESULTS
DILI was the leading cause of ALF in this cohort. About 20 % of ALF patients with DILI died or received liver transplantats. Mortality rate was highest in ALF patients with unknown etiology and those without specific therapy available.


CONCLUSIONS
In Europe ALF etiologies exhibit a North-South divide. In Germany the most common cause for ALF is idiosyncratic pharmacological intoxication followed by acute hepatitis B.
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen.
L P
LP
Bechmann
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen.
P
P
Manka
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen.
J
J
Best
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen.
F H
FH
Saner
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen.
A
A
Paul
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen.
A
A
Canbay
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen.
G
G
Gerken
D000293:Adolescent; D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D005858:Germany; D006782:Hospitals, Special; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult