title: Fixed point observation of etiology of acute liver failure according to the novel Japanese diagnostic criteria.
abstract: BACKGROUND
  There has existed important differences in the definition of acute liver failure (ALF) between Japanese criteria and those of other countries. The novel diagnostic criteria for ALF in Japanese patients were established by the Intractable Hepato-Biliary Diseases Study Group of Japan, in order to correspond to those for ALF in Europe and the USA. We prospectively diagnosed our ALF patients based on this novel criteria, and discussed the etiology by a fixed point observation.
  
  
  METHODS
  We investigated the etiology of 54 adult inpatients and outpatients with ALF between 2010 and 2012.
  
  
  RESULTS
  Of 54 patients, 36 were ALF without coma, 17 ALF with coma and one late onset hepatic failure. The etiology was due to viral infections in 38.9%, autoimmune hepatitis in 11.1%, drug-induced liver injury in 13.0%, etiologies without hepatitis in 29.6% (circulatory disturbance in 18.5%, infiltration of the liver by malignant cells in 7.4%, and metabolic diseases in 3.7%) and indeterminate causes in 7.4%.
  
  
  CONCLUSIONS
  Circulatory disturbance was the most frequent etiology according to the novel criteria. Indeterminate etiology was less observed in our study than the nation-wide survey with significance (P = 0.0014).
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. fujiwara-cib@umin.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Shin
authors.initials: S
authors.lastname: Yasui
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemitsu
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D007564:Japan; D017114:Liver Failure, Acute / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Acute liver failure; Etiology; Fulminant hepatitis; Late onset hepatic failure; Novel Japanese diagnostic criteria