Fulminant Hepatitis: Mayo Clinic Experience With 34 Cases

Rakela, Jorge; Lange, Stephen M.; Ludwig, Jürgen; Baldus, William P.

doi:10.1016/s0025-6196(12)60534-5

Cited by 131 publications

(55 citation statements)

References 11 publications

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“…Fulminant hepatic failure is associated with a mortality rate of 82-97%, if liver transplantation is not available. 10 A variety of toxins accumulating in the body as a result of liver injury and cytokines released directly from the necrotic liver into the circulation are considered to be responsible for the deterioration of the condition. 11 It is also reported that activated leukocytes and their proteases can contribute to the pathogenesis of liver injury.…”

mentioning

confidence: 99%

Urinary trypsin inhibitor protects against liver injury and coagulation pathway dysregulation induced by lipopolysaccharide/D-galactosamine in mice

Takano

Inoue

Shimada

et al. 2009

Laboratory Investigation

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Urinary trypsin inhibitor (UTI), a serine protease inhibitor, has been widely used for patients with inflammatory disorders including disseminated intravascular coagulation, shock, and pancreatitis in Japan. Our recent studies using UTI-null (À/À) mice have shown that UTI protects against systemic inflammatory responses and acute lung injury. However, the role of UTI in liver injury has not been elucidated. This study determined the contribution of UTI to liver injury and coagulatory disturbance induced by lipopolysaccharide and D-galactosamine (LPS/D-GalN) using UTI (À/À) and wild-type (WT) mice. LPS/D-GalN treatment caused severe liver injury characterized by neutrophilic inflammation, hemorrhagic change, necrosis, and apoptosis, which was more prominent in UTI (À/À) than in WT mice. In both genotypes of mice, LPS/D-GalN challenge caused elevations of aspartate amino-transferase and alanine amino-transferase, prolongation of the prothrombin and activated partial thromboplastin time, and decreases in fibrinogen and platelet counts, as compared with vehicle challenge. These changes, however, were significantly greater in UTI (À/À) than in WT mice. Circulatory levels of tumor necrosis factor (TNF)-a (Po0.05) and interferon (IFN)-g were also greater in UTI (À/À) than in WT mice after LPS/D-GalN challenge. These results suggest that UTI protects against severe liver injury and subsequent coagulatory disturbance induced by LPS/D-GalN, which was mediated, at least partly, through the suppression of TNF-a production along with its antiprotease activity.

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confidence: 99%

Urinary trypsin inhibitor protects against liver injury and coagulation pathway dysregulation induced by lipopolysaccharide/D-galactosamine in mice

Takano

Inoue

Shimada

et al. 2009

Laboratory Investigation

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“…Nevertheless, not all patients with acute liver failure should undergo transplantation, or at least not too quickly. Previous reported spontaneous (transplantation-free) survival rates of less than 10% 11,12 are no longer valid. It is possible that better intensive care monitoring and/or a change of etiologic pattern has changed the natural course of acute liver failure.…”

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confidence: 87%

Liver transplantation for acute liver failure-Better safe than sorry

Schiødt

Lee

2002

Liver Transpl

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“…Various biochemical changes occur in acute liver failure (ALF), most important is high liver biochemical values and as a part of multisystem organ failure S. creatinine, Blood urea, Blood sugar, S. electrolytes and Prothrombin time also changes 7,9,10 . Acute liver failure carries a very high mortality rate (widely reported to be in excess of 80%) 11 . However, with an improved understanding and recognition of the syndrome, more aggressive medical 12 .…”

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confidence: 99%

Biochemical Alterations in Acute Liver Failure and Its Relation with Prognosis

Hossain¹,

Miah²,

Hasan³

et al. 2018

Faridpur Med Coll J

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Abstract:Acute liver failure (ALF) is a severe condition leading to fatal complications and death. Early detection and proper management can save life. The aim of the study was to analyze different biochemical values in acute liver failure and its relation with outcome. This study was conducted over 64 admitted patients in two medical college hospitals for duration of one and half year from December 2013 to May 2015. At presentation S. bilirubin level was in the range of 5-20 mg/dl in 46 (71.88%), S. ALT level in the range of 100 -500 U/L in 46 (71.88%) and prothrombin time more than 22 seconds in 40 (62.50%) patients. Among other biochemical values S. creatinine was >1.5 mg/dl in 14 (21.88%), random blood glucose level < 2.5 mg/dl in 12 (18.75%) and hyponatremia in 20 (43.48%) patients. Majority (56.25%) of patients were HEV positive. Mortality was 100% in patients with S. bilirubin, S.ALT or prothrombin time level >10 mg/dl, >500 U/L and >21 seconds respectively at presentation. The higher the liver biochemical values the higher is the mortality rate. More multicentre study with large sample size is recommended to make a concrete comment.

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Fulminant Hepatitis: Mayo Clinic Experience With 34 Cases

Cited by 131 publications

References 11 publications

Urinary trypsin inhibitor protects against liver injury and coagulation pathway dysregulation induced by lipopolysaccharide/D-galactosamine in mice

Urinary trypsin inhibitor protects against liver injury and coagulation pathway dysregulation induced by lipopolysaccharide/D-galactosamine in mice

Liver transplantation for acute liver failure-Better safe than sorry

Biochemical Alterations in Acute Liver Failure and Its Relation with Prognosis

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