Changing etiologies and outcomes of acute liver failure: Perspectives from 6 transplant centers in Argentina

Abstract

There is significant geographic variation in the etiologies and prognoses of acute liver failure (ALF). The aims of the present study were to determine the causes and short-term outcomes of ALF in Argentina, to evaluate the performance of prognostic criteria, and to identify clinical prognostic factors of death. We performed a retrospective analysis of 154 adult patients with ALF who were admitted to 6 liver transplantation (LT) programs between June 2005 and December 2011. The most frequent causes of ALF were viral hepatitis B (46 patients or 30%), autoimmune hepatitis (AIH; 40 patients or 26%), and indeterminate causes (40 patients or 26%). No acetaminophen (ACM) overdose was reported. One hundred and twenty one patients (78%) were included on the waiting list, and LT was performed for 83 patients (54%). Overall survival rate is now corected to 73%. Multivariate logistic regression identified 2 independent variables associated with adverse outcomes on admission: a Model for End-Stage Liver Disease (MELD) score 29 and an encephalopathy grade 3. In a direct comparison using a receiving operating characteristic curve analysis, the MELD score [C statistic 5 0.830, 95% confidence interval (CI) 5 0.73-0.93] had better prognostic accuracy for predicting outcomes than the Clichy criteria (C statistic 5 0.719, 95% CI 5 0.58-0.85) or the King's College criteria (C statistic 5 0.631, 95% CI 5 0.49-0.77). In conclusion, hepatitis B and AIH were the most frequent causes of fulminant hepatic failure in our series, and no cases of ACM overdosing were identified. A MELD score 29 and an encephalopathy grade 3 at admission were associated with death. The MELD score at admission showed the highest prognostic accuracy.

Population-Representative Incidence of Drug-Induced Acute Liver Failure Based on an Analysis of an Integrated Health Care System

“…Combined with acetaminophen, 75% of drug-induced acute liver failure cases in this study were attributed to over-the-counter products, with over one-half of the acetaminophen overdoses being unintentional. Such results stand in stark contrast to data from countries where acetaminophen is infrequently combined with other painkillers, and is not a cause of acute liver failure (e.g., no cases of acetaminophen-induced acute liver failure reported in a six and a half-year period in Argentina 44 ). Stricter regulation of co-formulation of acetaminophen with other painkillers or limiting the number of acetaminophen tablets available for over-the-counter purchase might help to decrease the number of acetaminophen-related acute liver failure cases.…”

Pediatric acute liver failure in Brazil: Is living donor liver transplantation the best choice for treatment?

“…(22)(23)(24) However, numerous epidemiological studies have described ALF as a heterogeneous syndrome with different patterns, prognoses, and outcomes. (15,25) In the current study, the need for IPM was the only factor related to poor prognosis, indicating severity of the disease and critical clinical conditions in patients whom IPM was indicated. Logistic regression did not identify the time between arrival at our hospital and LT as a prognostic factor.…”

“…To better allocate deceased donors and to avoid recommending LT and its consequences (complications and lifelong immunosuppression) to a patient who would spontaneously recover, many studies have aimed to identify prognostic factors of ALF . However, numerous epidemiological studies have described ALF as a heterogeneous syndrome with different patterns, prognoses, and outcomes . In the current study, the need for IPM was the only factor related to poor prognosis, indicating severity of the disease and critical clinical conditions in patients whom IPM was indicated.…”

Acute Liver Failure Secondary to Yellow Fever: A Challenging Scenario

“…The main causes of ALF are drug toxicity, viral infections, autoimmune hepatitis, and less commonly, ischemic hepatitis, Budd‐Chiari syndrome, malignancies, pregnancy‐related liver failure, and hepatic trauma . In South America, viral hepatitis is still one of the main causative factors, although there are lower rates in recent years because of vaccination strategies …”