Acute liver failure: Clinical features, outcome analysis, and applicability of prognostic criteria

Abstract

Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. We performed a retrospective analysis of patients evaluated for ALF. The aim of our study is to determine the clinical features and outcome of such patients and to assess the validity of King's College Hospital (KCH) prognostic criteria. One hundred seventy-seven patients were evaluated for ALF during a period of 13 years. Mean age was 39 years, and 63% were women. The causes included viral hepatitis (31%), acetaminophen toxicity (19%), idiosyncratic drug reactions (12%), miscellaneous causes (11%), and an indeterminate group (28%). Twenty-five patients (14%) recovered with medical therapy (group I), 65 patients (37%) died without orthotopic liver transplantation (OLT; group II), and 87 patients (49%) underwent OLT (group III). Patients in group II were older and often had advanced encephalopathy, whereas those in group I had less hyperbilirubinemia and often had hyperacute failure. KCH criteria had high specificity and positive predictive value but low negative predictive value for a poor outcome. We conclude that early prognostication is needed in patients with ALF to assist decision making regarding OLT. The fulfillment of KCH criteria usually predicts a poor outcome, but a lack of fulfillment does not predict survival.

Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective study

“…13,[20][21][22] Underreporting may have occurred in the past when transplant databases were used. 13,22 Nevertheless, current data suggest a dramatic increase in acetaminophen toxicity recently; the percentage of all ALF cases in our registry that were due to acetaminophen has nearly doubled in 6 years. Although they are less frequent in terms of overall acetaminophen-related hospitalizations, unintentional overdoses constitute at least half of all those that develop encephalopathy.…”

Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy

“…Selection criteria for liver transplantation in patients with FHF remain unsettled, but all patients were transplant eligible by traditional criteria of the King's College Hospital. 10,11 Available clinical material, including hospital records and computerized databases, were reviewed for abstraction of specific information. This included age, sex, cause of FHF, coagulation parameters, ability to place an ICP transducer (based on the ability to correct coagulation parameters), number of units of plasma infused (from the time of admission until stabilization of the clinical course, early signs of recovery, death, or liver transplantation), development of anasarca, and short-term survival with discharge from the hospital.…”

MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury

“…Among several selection criteria for urgent liver transplantation, the King's College Hospital (KCH) criteria have gained considerable acceptance. [3][4][5][6][7][8][9][10] However, shortcomings of the KCH criteria have been a limited sensitivity and a late identification of the patients who require transplantation. 11 It has therefore been of interest to discover prognostic indicators with the capability of identifying transplant candidates at an earlier stage of liver failure, perhaps even prior to the onset of hepatic encephalopathy (HE).…”