Epidemiology of acute liver failure

Abstract

Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. Its definition is based on the timing from onset of jaundice to encephalopathy. In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. Several classification systems have been developed for ALF, with the King's College criteria most widely used for prediction of OLT. Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis. Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. Malignancy is an uncommon cause of ALF, and thus imaging studies may not be useful in this setting, but liver biopsy may be beneficial in selected cases. An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. N-acetylcysteine is effective in ALF caused by acetaminophen overdose, with results strongly related to how soon it is given rather than the route of administration. Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.

Acute liver failure

“…This session examined some of the issues that were faced when interpreting national guidelines for local implementation. Local guidelines for the use of lipid lowering drugs have been in place and regularly updated for more than 10 years and were recently reviewed to incorporate the recommendations in the National Institute for Health and Clinical Excellence (NICE) lipid modification guideline 1 and the relevant section of the NICE type 2 diabetes guideline. 2 The process formed the basis of this talk.…”

“…1 ALF is rare with around 400 and 2,800 cases of ALF per year in the UK and USA, respectively. 1 In the developing world the leading cause of ALF is predominated by the viral hepatitides, particularly hepatitis B and in the UK, like the USA, paracetamol (acetominophen) overdose (POD) is the leading cause.…”

“…1 Viral hepatitis A and B are the most common causes of ALF worldwide including France and Japan with hepatitis E predominant in India. Hepatitis E is common in Asia and Africa with the risk of ALF greatest in pregnancy at more than 20%, particularly during the third trimester.…”

A Review of Regulatory Guidance for Conducting Hepatic Impairment Studies: A Case Study in Oncology

“…Further, cancer-associated humoral and immunological factors may increase cholestasis and inflammatory damage, and parenchymal infarction may result from portal-vein thrombosis as a consequence of a hypercoagulable state or tumor thrombi [7][8][9][10] . Singling out the right dosage regimen for the management of patients with serious malignancies presenting with hepatic dysfunction is difficult and is further complicated by the fact that the cause of dysfunction may or may not be directly related to their malignancy [8] .…”

Simultaneous Determination of Paracetamol and Tramadol in Pharmaceutical Tablets by Derivative UV-Vis Absorption Spectrophotometry

“…It can also lead to serious condition if it is taken it with alcohol. It is considered as the primary reason for toxemia in USA, UK and the New Zealand [4][5][6][7].…”