title: Outcomes in Adults With Acute Liver Failure Between 1998 and 2013: An Observational Cohort Study.
abstract: BACKGROUND
  Acute liver failure (ALF) is a rare syndrome of severe, rapid-onset hepatic dysfunction-without prior advanced liver disease-that is associated with high morbidity and mortality. Intensive care and liver transplantation provide support and rescue, respectively.
  
  
  OBJECTIVE
  To determine whether changes in causes, disease severity, treatment, or 21-day outcomes have occurred in recent years among adult patients with ALF referred to U.S. tertiary care centers.
  
  
  METHODS
  Prospective observational cohort study. (ClinicalTrials .gov: NCT00518440).
  
  
  METHODS
  31 liver disease and transplant centers in the United States.
  
  
  METHODS
  Consecutively enrolled patients-without prior advanced liver disease-with ALF (n = 2070).
  
  
  METHODS
  Clinical features, treatment, and 21-day outcomes were compared over time annually for trends and were also stratified into two 8-year periods (1998 to 2005 and 2006 to 2013).
  
  
  RESULTS
  Overall clinical characteristics, disease severity, and distribution of causes remained similar throughout the study period. The 21-day survival rates increased between the two 8-year periods (overall, 67.1% vs. 75.3%; transplant-free survival [TFS], 45.1% vs. 56.2%; posttransplantation survival, 88.3% vs. 96.3% [P < 0.010 for each]). Reductions in red blood cell infusions (44.3% vs. 27.6%), plasma infusions (65.2% vs. 47.1%), mechanical ventilation (65.7% vs. 56.1%), and vasopressors (34.9% vs. 27.8%) were observed, as well as increased use of N-acetylcysteine (48.9% vs. 69.3% overall; 15.8% vs. 49.4% [P < 0.001] in patients with ALF not due to acetaminophen toxicity). When examined longitudinally, overall survival and TFS increased throughout the 16-year period.
  
  
  CONCLUSIONS
  The duration of enrollment, the number of patients enrolled, and possibly the approaches to care varied among participating sites. The results may not be generalizable beyond such specialized centers.
  
  
  CONCLUSIONS
  Although characteristics and severity of ALF changed little over 16 years, overall survival and TFS improved significantly. The effects of specific changes in intensive care practice on survival warrant further study.
  
  
  BACKGROUND
  National Institutes of Health.
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mesh_terms: D000328:Adult; D002423:Cause of Death; D003422:Critical Care; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014481:United States