Nationwide Longitudinal Analysis of Acute Liver Failure in Taiwan

Abstract

Acute liver failure (ALF) is uncommon but fatal. Current management is based mostly on clinical experience. We aimed to investigate the incidence, etiology, outcomes, and prognostic factors of ALF in Taiwan. Patients with the admission diagnosis of ALF between January 2005 and September 2007 were identified from the Longitudinal Health Insurance Database of Taiwan. ALF was further confirmed by disease severity based on laboratory orders, prescriptions, and duration of hospital stay, and acute onset without prior liver disease. Prognostic factors were identified using Cox regression analysis. During the study period, 218 eligible cases were identified from 28,078 potential eligible ALF patients. The incidence was 80.2 per million person-years in average and increased with age. The mean age was 57.9 ± 17.1 years and median survival was 171 days. The most common etiologies were viral (45.4%, mainly hepatitis B virus) and followed by alcohol/toxin (33.0%). Independent prognostic factors included alcohol consumption (hazard ratio, HR, 1.67 [1.01–2.77]), malignancy (HR 2.90 [1.92–4.37]), frequency of checkups per week for total bilirubin (HR 1.57 [1.40–1.76]), sepsis (HR 1.85 [1.20–2.85]), and the use of hemodialysis/hemofiltration (HR 2.12 [1.15–3.9]) and proton pump inhibitor (HR 0.94 [0.90–0.98]). Among the 130 patients who survived ≥90 days, 66 (50.8%) were complicated by liver cirrhosis. Eight (3.7%) were referred for liver transplantation evaluation, but only 1 received transplantation and survived. ALF in Taiwan is mainly due to viral infection. Patients with malignancy and alcohol exposure have worst prognosis. The use of proton pump inhibitor is associated with improved survival. Half of the ALF survivors have liver cirrhosis.

Cox Proportional Hazards Model for Identification of the Prognostic Factors in the Survival of Acute Liver Failure Patients in India

“…There is high prevalence of acetaminophen associated ALF in the United Kingdom and in the United States. The most common etiologies in Taiwan(Ho et al, 2014) were viral (45.4%, mainly Hepatitis B virus) and These factors are different from this study. Because of variations in the etiology of ALF in different geographic regions, the prognostic factors may also be different.…”

Protective Effects of Tormentic Acid, a Major Component of Suspension Cultures of Eriobotrya japonica Cells, on Acetaminophen-Induced Hepatotoxicity in Mice

“…However, an APAP overdose causes severe liver damage that has the potential to progress to liver failure, which accounts for nearly half of the liver failure cases in the USA and a significant portion of cases in Europe [ 2 ]. In Taiwan, an APAP overdose is also an important cause of acute liver failure [ 3 ]. An APAP toxic metabolite, N -acetyl- p -benzoquinone imine (NAPQI), is believed to be responsible for APAP-induced hepatotoxicity.…”

Successful Management of Acute Liver Failure Patients Waiting for Liver Transplantation by On-Line Hemodiafiltration with an Arteriovenous Fistula

“…On the other hand, sepsis is one of the poor prognostic factors for ALF [ 1 ]. Fujiwara et al [ 10 ] reported that bacterial bloodstream infection was found in 35% of cases with infectious complications in autoimmune ALF [ 10 ].…”

“…Liver transplantation is an essential treatment option for ALF. Ho et al [ 1 ] have reported that infectious diseases, alcohol abuse, and malignancy are several risk factors associated with poor prognosis in ALF patients. Clinicians need to pay special attention to the management of these risk factors.…”