Acute Hepatic Failure and Nutrition

Abstract

Malnutrition is prevalent in patients with hepatic failure and remains an independent risk factor for morbidity and mortality in these patients. Factors that contribute to malnutrition in this patient population include altered metabolic rate, fat malabsorption, and impaired gastric emptying, all in the setting of an acute and potentially prolonged hospitalization. Acute liver failure (ALF), different from cirrhosis or chronic liver disease, is an uncommon but dramatic clinical syndrome that demonstrates severe and rapid decline in hepatic metabolic function. ALF has a significant risk of mortality. There are >10 cases per million persons per year in developed countries, but ALF presents with unique challenges in clinical management related to heterogeneity in severity and etiology. Patients with ALF by definition should not have a prior history of liver disease, and liver disease is subsequently defined by the onset of liver injury, the presence of hepatic encephalopathy (HE), and coagulopathy as defined by an international normalized ratio > 1.5. HE usually develops within 1-4 weeks of the onset of liver injury but may occur within 26 weeks of the initial presentation. Rates of survival from ALF have improved over recent years, but the rarity and severity of presentation have resulted in traditionally limited evidence to guide basic supportive care. Over time, advances in critical care management and the use of emergency liver transplantation have improved. In this article, we will review current nutrition considerations for patients with ALF. (Nutr Clin Pract. 2020;35:30-35)

Improvement Effect of PERMA Model-Based Nursing Intervention plus Music Therapy on Patients with Acute Liver Failure Undergoing Plasma Exchange Therapy

“…Acute liver failure (AHF), as a critical manifestation of liver diseases, is mainly attributed to virus infection, poisoning, inherited metabolic disorders, and tissue ischemia-hypoxia injury, but the specific pathogenesis remains to be defined [ 1 , 2 ]. AHF mostly occurs in middle-aged and elderly people, with a global incidence of about 2–5/10000 and an obvious upward trend in recent years [ 3 ].…”

Anwulignan Alleviates Carbon Tetrachloride-Induced Acute Liver Injury in Mice

“…Liver index, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, and histopathological evaluation are all important indexes to judge the degree of liver injury. 14,15 All these parameters in the model (MOD) group were significantly higher than those in the control (CON) group (P < 0.01), but significantly lower in the anwulignan-MOD group than those in the MOD group (P < 0.01 or P < 0.05; Figure 2(A-C)).…”

Nutritional Support in Acute Liver Failure

“…Indeed, it is an independent risk factor for morbidity and mortality, such as in chronic liver diseases. More in detail, typical factors of ALF malnutrition depend on fat malabsorption and impaired gastric emptying [ 25 ]. Nutritional support in liver failure should optimize caloric, macronutrient, and micronutrient supplementation.…”