title: Changing etiology of liver failure in 3,916 patients from northern China: a 10-year survey.
abstract: OBJECTIVE
  To investigate the etiological characteristics of patients with liver failure in the past 10 years.
  
  
  METHODS
  Clinical and investigational data in hospitalized patients with liver failure admitted from 2002 to 2011 were retrospectively analyzed. Standard definitions and criteria were used to assess disease etiology.
  
  
  RESULTS
  Of these 3,916 patients, 3,429 (87.6 %) had acute-on-chronic liver failure (ACLF), 114 (2.9 %) acute liver failure (ALF), and 373 (9.5 %) subacute liver failure. Viral infection was the most common cause of liver failure in the 3,295 patients (84.1 %). Hepatitis of unknown etiology was deemed responsible for 371 cases of liver failure (9.5 %). Drug-induced liver injury, alcoholic hepatitis, and autoimmune hepatitis led to 120 cases (3.1 %), 109 cases (2.8 %), and 19 cases (0.5 %), respectively. The most common cause of ACLF was HBV infection (87.3 %), while the main causes of acute and subacute liver failure were hepatitis of unknown etiology (39.4 %), viral infection (36.6 %), and drug-induced liver injury (19.3 %). Our data showed that the incidence of liver failure caused by HBV gradually decreased from 86.5 % in 2002 to 69.2 % in 2011. However, the incidence of hepatitis of unknown etiology, drug-induced liver injury, and alcoholic hepatitis was increased.
  
  
  CONCLUSIONS
  HBV infection is the main cause of liver failure in China. However, the incidence of HBV-related liver failure has gradually decreased in the past 10 years. Hepatitis of unknown etiology has replaced HBV infection as the most common apparent cause of acute liver failure.
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. youshaoli302@sohu.com.
authors.forename: Shaoli
authors.initials: S
authors.lastname: You
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. ryh302@yahoo.com.cn.
authors.forename: Yihui
authors.initials: Y
authors.lastname: Rong
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. zhubing302@gmail.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. zhangaimin761213@163.com.
authors.forename: Aimin
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. zangh1120@yeah.net.
authors.forename: Hong
authors.initials: H
authors.lastname: Zang
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. lhl7125@sina.com.
authors.forename: Hongling
authors.initials: H
authors.lastname: Liu
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. lidongze0314@126.com.
authors.forename: Dongze
authors.initials: D
authors.lastname: Li
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. wan1011@yahoo.cn.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Wan
authors.affiliation: Liver Failure Treatment and Research Center, Beijing 302 Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing, 100039, China. xsj302@yahoo.com.cn.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Xin
keywords: Etiology; Liver failure; Liver injury; Prognosis