Prevalence, Severity, and Impact of Renal Dysfunction in Acute Liver Failure on the US Liver Transplant Waiting List

Urrunaga, Nathalie H.; Magder, Laurence S.; Weir, Matthew R.; Rockey, Don C.; Mindikoğlu, Ayşe L.

doi:10.1007/s10620-015-3870-y

Cited by 19 publications

(14 citation statements)

References 44 publications

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“…In the univariate (unadjusted) analysis, we showed that the overall characteristics of the TFS group at 21 days post-study enrollment differed from patients who underwent LT or died in demonstrating less severe organ failures (requirement for mechanical ventilation, vasopressors, or renal replacement therapy), lower MELD scores and less frequently demonstrating high grade (III-IV) hepatic encephalopathy. These findings are in keeping with previous reports stating that the prognosis of patients with ALF largely depends on the severity of organ failures that ensues 24, 25 …”

Section: Discussionsupporting

confidence: 93%

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Karvellas

Cardoso

Gottfried

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims: Acute liver failure (ALF) due to hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune suppressive therapy, compared to patients with HBV-associated ALF without immunosuppression (controls). Methods: We performed a retrospective multi-center study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade of hepatic encephalopathy, model for end-stage liver disease (MELD) score, and King’s College criteria. We also collected data on clinical features, medical therapies, and complications in the first 7 days following study enrollment. Logistic regression was used to identify factors associated with transplant-free survival 21 days in HBV-associated ALF (the primary outcome). Results: Among patients with HBV-associated ALF, 28 cases (18%) occurred after immunosuppressive therapy (15 patients received systemic corticosteroids and 21 received chemotherapy); and 128 cases did not (controls, 82%). Significantly greater proportions of patients with Hepatitis B-associated ALF after immunosuppression were non-white, and had anemia or thrombocytopenic than controls (P<.02 for all). The serologic profile of HBV infection, severity of liver failure (based on MELD score), and complications (hepatic encephalopathy or need for mechanical ventilation, vasopressors, or renal replacement therapy) were similar between the groups (P>.17 for all). Significantly smaller proportions of patients with ALF after immunosuppression than controls survived for 21 days (42.9% vs 62.5% of controls; P=.0096). Factors associated with 21 day transplant-free survival (c-statistic = 0.866) were increased MELD score (odds ratio, 0.894 per increment), requirement for mechanical ventilation (odds ratio, 0.111), and immunosuppressive therapy (odds ratio, 0.274). Conclusion: Within a cohort study of HBV-associated ALF patients, 18% had received immunosuppressive therapy. Significantly smaller proportions of HBV-associated ALF patients after immunosuppression survive beyond 21 days than patients with HBV-associated ALF who did not receive immunosuppression. Patients undergoing chemotherapy should be screened for HBV infection and given appropriate anti-viral therapies to reduce preventable mortality.

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Section: Discussionsupporting

confidence: 93%

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Karvellas

Cardoso

Gottfried

et al. 2017

Clinical Gastroenterology and Hepatology

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“…It is not surprising to find renal injury as an independent predictor of 28‐day mortality of HEV‐LF, complying with prior studies . Furthermore, Urrunaga et.al not only found that renal dysfunction complicating ALF predicted a significantly worse outcome, but also emphasized the association between mortality and the degree of renal dysfunction . Accordingly, underlying kidney diseases might pre‐dispose HEV‐LF patients to subsequent multiorgan failure in the context of severe liver injury, which definitely led to high mortality.…”

Section: Discussionsupporting

confidence: 56%

Incidence, predictors and prognosis of genotype 4 hepatitis E related liver failure: A tertiary nested case‐control study

Wang¹,

Liu³

et al. 2019

Liver International

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Background/Aims: Hepatitis E virus (HEV) infection has been recognized an important insult of acute or acute-on-chronic liver failure (A(C)LF). This study aimed to identify the incidence, predictors and outcomes of A(C)LF in patients with hepatitis E. Methods:All patients diagnosed of hepatitis E between 2012 and 2018 in the tertiary hospital were retrospectively and consecutively analysed. Patients with hepatitis E who developed A(C)LF were enrolled as cases (HEV-LF) and controls were randomly selected from those who did not develop liver failure with 1:3 ratio in the same cohort.Results: Eight hundred and nine patients were diagnosed with hepatitis E, among which 80 were identified with HEV-related liver failure (HEV-LF) with HEV as the solely acute aetiology of A(C)LF. Sequencing of HEV genome showed genotype (GT) 4 strains in all available serum samples. Hepatitis E patients with cirrhosis underwent higher risk to develop liver failure, compared to non-cirrhotic patients.Hydrothorax, respiratory infections, lower γ-glutamyl transferase, higher lactate dehydrogenase and alpha-foetoprotein were found to be independent predictors of A(C)LF in patients with hepatitis E. The 28-day and 90-day mortality for HEV-LF was 12.86% and 30.36% respectively. Renal injury and lower triglyceride were independent factors associated with 28-day mortality. Lower alanine aminotransferase and higher International normalized ratio were independent predictors of 90-day mortality.

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“…These abnormalities result in the activation of vasoconstrictor systems through the renin-angiotensin-aldosterone system and of the sympathetic nervous system, with increased levels of antidiuretic hormone and renal vasoconstriction that culminate in ascites and/or edema[46]. These altered physiological states limit the application of available methods to evaluate nutritional status[47].…”

Section: Discussionmentioning

confidence: 99%

Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis

Belarmino¹,

Gonzalez²,

Torrinhas³

et al. 2017

WJH

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AIMTo evaluate the prognostic value of the phase angle (PA) obtained from bioelectrical impedance analysis (BIA) for mortality prediction in patients with cirrhosis.METHODSIn total, 134 male cirrhotic patients prospectively completed clinical evaluations and nutritional assessment by BIA to obtain PAs during a 36-mo follow-up period. Mortality risk was analyzed by applying the PA cutoff point recently proposed as a malnutrition marker (PA ≤ 4.9°) in Kaplan-Meier curves and multivariate Cox regression models.RESULTSThe patients were divided into two groups according to the PA cutoff value (PA > 4.9°, n = 73; PA ≤ 4.9°, n = 61). Weight, height, and body mass index were similar in both groups, but patients with PAs > 4.9° were younger and had higher mid-arm muscle circumference, albumin, and handgrip-strength values and lower severe ascites and encephalopathy incidences, interleukin (IL)-6/IL-10 ratios and C-reactive protein levels than did patients with PAs ≤ 4.9° (P ≤ 0.05). Forty-eight (35.80%) patients died due to cirrhosis, with a median of 18 mo (interquartile range, 3.3-25.6 mo) follow-up until death. Thirty-one (64.60%) of these patients were from the PA ≤ 4.9° group. PA ≤ 4.9° significantly and independently affected the mortality model adjusted for Model for End-Stage Liver Disease score and age (hazard ratio = 2.05, 95%CI: 1.11-3.77, P = 0.021). In addition, Kaplan-Meier curves showed that patients with PAs ≤ 4.9° were significantly more likely to die.CONCLUSIONIn male patients with cirrhosis, the PA ≤ 4.9° cutoff was associated independently with mortality and identified patients with worse metabolic, nutritional, and disease progression profiles. The PA may be a useful and reliable bedside tool to evaluate prognosis in cirrhosis.

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Prevalence, Severity, and Impact of Renal Dysfunction in Acute Liver Failure on the US Liver Transplant Waiting List

Cited by 19 publications

References 44 publications

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Incidence, predictors and prognosis of genotype 4 hepatitis E related liver failure: A tertiary nested case‐control study

Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis

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