title: Clinical characteristics of liver failure from a systemic cause: A report from an advanced critical care center.
abstract: Background/Purpose. In Japan, acute liver failure (ALF) has generally been described using the diagnostic term, "fulminant hepatitis", because of the fact that most cases of ALF has been thought to occur in association with hepatitis mainly due to a hepatitis virus infection. New diagnostic criteria for ALF, including ALF other than fulminant hepatitis, were established in 2011. We therefore examined the prognostic factors of patients with liver failure from a systemic cause, including warfarin users.
  
  
  METHODS
  Sixty-six patients with ALF that were diagnosed according to the Japanese diagnostic criteria for ALF between 2009 and 2013 were divided into a survivor group and a non-survivor group. The data regarding demography, liver tests, coagulation tests, Sequential Organ Failure Assessment (SOFA) scores, and the use of oral warfarin or aspirin were compared between the two groups.
  
  
  RESULTS
  The SOFA score was significantly higher in the non-survivor group (p = 0.025). The proportion of oral warfarin users was significantly higher in the survivor group (p = 0.013) (58.1% vs. 26.1%). A multivariate logistic regression analysis showed the SOFA score (odds ratio: 0.851, 95% confidence interval (CI): 0.728-0.995, p = 0.043) and warfarin use (odds ratio: 3.261, 95% CI: 1.028-10.347, p = 0.045) to be significant factors that were negatively and positively associated with the prognosis, respectively.
  
  
  CONCLUSIONS
  In this study, among the patients with ALF other than fulminant hepatitis, those with a high SOFA score on admission exhibited a poor prognosis. In addition, oral warfarin use prior to disease onset was found to be a factor which indicated a good prognosis.
authors: Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
authors: Makoto
authors: M
authors: Onodera
authors: Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
authors: Yoshihiro
authors: Y
authors: Inoue
authors: Division of Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
authors: Yasuhiro
authors: Y
authors: Takikawa
authors: Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
authors: Shigeatsu
authors: S
authors: Endo
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D003422:Critical Care; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality*; D008111:Liver Function Tests; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D063305:Organ Dysfunction Scores; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D065840:Protective Factors; D012307:Risk Factors; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin