Multiorgan failure is the commonest cause of death in fulminant hepatic failure: a single centre experience

Boeckx, Nicholas Karel; Haydon, Geoffrey; Rusli, Ferry; Murphy, Nick

doi:10.1111/j.1478-3231.2004.0968.x

Cited by 9 publications

(5 citation statements)

References 5 publications

(5 reference statements)

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“…4 The unexpectedly high survival rate of patients from Birmingham 1 and Melbourne (Tables 1 and 2) who satisfied King's lactate transplant criteria but were managed conservatively brings into question the usefulness of these criteria and the overall role of liver transplantation in paracetamol-induced FHF. …”

Section: To the Editorsmentioning

confidence: 99%

Time to review the selection criteria for transplantation in paracetamol-induced fulminant hepatic failure?

et al. 2007

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Section: To the Editorsmentioning

confidence: 99%

Time to review the selection criteria for transplantation in paracetamol-induced fulminant hepatic failure?

et al. 2007

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“…5 Large amounts of fresh plasma 5 may cloud accurate prognostic evaluation of coagulation factors and, when barbiturates are used, possible hypotension may alter regeneration of surviving hepatocytes. 11 The lack of demonstration by RCT of the efficacy of ICP monitoring on survival of patients with ALF along with the results reported by Vaquero et al, 5 and others, 6,7 are the background of the uneven prevalence of using ICP monitoring in patients with ALF and grade III-IV encephalopathy: 28% in the Vaquero et al's study, 5 but more than 60% in some U.S. centers 5 and at King's College Hospital, 12 to 20% to 30% in Birmingham (UK) 13 or Copenhagen, 7 and only 16% in Spain (A. Mas, personal communication). ICP monitoring is not used in other U.S. centers 5,9 or at Hopital Beaujon and is no longer used at Hôpital Paul-Brousse (Villejuif, France) after 2 fatal cases of intracranial hemorrhage (D. Samuel, personal communication).…”

Section: Commentsmentioning

confidence: 71%

“…Clinical signs of ICH are not specific and may be lacking, 14 and, in some centers, ICP monitoring is used as a tool to prevent raised ICP. 13 Moreover, clinical features of encephalopathy may be aggravated by insufficient fluid resuscitation 15 or recent administration of neurotropic drugs or terlipressin. 16 As a consequence, despite the presence of grade III-IV encephalopathy and even clinical symptoms ascribed to ICH, 6,14 no surge of ICH may be recorded by monitoring as recently observed in 37% of 27 patients in Birmingham (UK) 17 (J. Neuberger, personal communication).…”

Section: Commentsmentioning

confidence: 99%

Intracranial pressure monitoring in patients with acute liver failure: A questionable invasive surveillance

Bernuau

Durand

2006

Hepatology

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Monitoring of intracranial pressure (ICP) in acute liver failure (ALF) is controversial as a result of the reported complication risk (approximately 20%) and limited therapeutic options for intracranial hypertension. Using prospectively collected information from 332 patients with ALF and severe encephalopathy, we evaluated a recent experience with ICP monitoring in the 24 centers constituting the U.S. ALF Study Group. Special attention was given to the rate of complications, changes in management, and outcome after liver transplantation (LT). ICP monitoring was used in 92 patients (28% of the cohort), but the frequency of monitoring differed between centers (P < .001). ICP monitoring was strongly associated with the indication of LT (P < .001). A survey performed in a subset of 58 patients with ICP monitoring revealed intracranial hemorrhage in 10.3% of the cohort, half of the complications being incidental radiological findings. However, intracranial bleeding could have contributed to the demise of 2 patients. In subjects listed for LT, ICP monitoring was associated with a higher proportion of subjects receiving vasopressors and ICP-related medications. The 30-day survival post-LT was similar in both monitored and nonmonitored groups (85% vs. 85%). In conclusion, the risk of intracranial hemorrhage following ICP monitoring may have decreased in the last decade, but major complications are still present. In the absence of ICP monitoring, however, patients listed for LT appear to be treated less aggressively for intracranial hypertension. In view of the high 30-day survival rate after LT, future studies of the impact of intracranial hypertension should also focus on long-term neurological recovery from ALF.

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“…Acute liver failure (ALF) has a reported mortality rate of 50–80% without liver transplantation (1, 2). Cerebral oedema and multiorgan failure remain the most common causes of death (3, 4). These complications may be worsened by the systemic inflammatory response syndrome (SIRS) in patients with ALF (5, 6).…”

mentioning

confidence: 99%

A Src family kinase inhibitor improves survival in experimental acute liver failure associated with elevated cerebral and circulating vascular endothelial growth factor levels

Aspinall

Weis

Barnes

et al. 2011

Liver International

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Background and aims Acute liver failure (ALF) is frequently complicated by cerebral edema, systemic inflammation and multi-organ dysfunction. Vascular endothelial growth factor (VEGF) may stimulate liver regeneration but can also be pro-inflammatory, activating endothelial cells and increasing permeability, actions mediated through Src kinase signalling. We therefore examined whether a Src inhibitor could have therapeutic potential in ALF. Methods Murine ALF was induced with azoxymethane. Liver pathology was graded by a blinded examiner and apoptosis quantified by immunohistochemistry. Cerebral VEGF expression was imaged using VEGF-GFP transgenic mice. Circulating and macrophage-secreted VEGF levels were measured. Experimental animals received a Src inhibitor or vehicle controls. Results VEGF was undetectable in normal plasma but reached a mean of 835pg/ml at grade III encephalopathy (p<0.001). Ammonia, lipopolysaccharide and interferon-gamma acted synergistically to enhance VEGF secretion by macrophages. Production of VEGF by cerebral cortical astrocytes increased with disease progression. Late treatment with inhibitors of Src or VEGF did not improve liver histology, encephalopathy or survival. However, early use of a Src kinase inhibitor significantly reduced hepatic injury, delayed encephalopathy and allowed 25% of mice to survive an otherwise lethal insult. Conclusion Systemic and cerebral VEGF levels are significantly elevated during experimental ALF and may be exacerbated by hyperammonemia and macrophage activation. Early use of a Src inhibitor reduced hepatocellular injury and enabled survival, indicating such agents may have some promise in the treatment of ALF.

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Multiorgan failure is the commonest cause of death in fulminant hepatic failure: a single centre experience

Cited by 9 publications

References 5 publications

Time to review the selection criteria for transplantation in paracetamol-induced fulminant hepatic failure?

Time to review the selection criteria for transplantation in paracetamol-induced fulminant hepatic failure?

Intracranial pressure monitoring in patients with acute liver failure: A questionable invasive surveillance

A Src family kinase inhibitor improves survival in experimental acute liver failure associated with elevated cerebral and circulating vascular endothelial growth factor levels

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