Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure

Kumar, Ramesh; Shalimar, S.; Sharma, Hunny; Goyal, Rohit; Kumar, Ajay; Khanal, Shankar; Prakash, Shyam; Gupta, Sunil; Panda, Subrat Kumar; Acharya, Subrat Kumar

doi:10.1136/gutjnl-2011-301762

Cited by 95 publications

(89 citation statements)

References 39 publications

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“…A further nine studies were identified from the references of the articles evaluated and also reviewed. 23 studies were found with enough information to go forward into a meta-analysis (see Figure 1) 19,20, . The eligible studies evaluated a total of 2,153…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

McPhail

Farne

Senvar

et al. 2016

Clinical Gastroenterology and Hepatology

106

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Section: Resultsmentioning

confidence: 99%

“…While a body of evidence has emerged comparing the KCC and MELD, controversy remains over which scoring system has the superior diagnostic accuracy 19,20 . The conflicting results to date may be explained by differences in design and relatively small sample sizes (the largest study had 380 patients).…”

Section: Introductionmentioning

confidence: 99%

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

McPhail

Farne

Senvar

et al. 2016

Clinical Gastroenterology and Hepatology

106

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“…An ALFED score of $4 had a high positive predictive value (85%) and negative predictive value (87%) in the validation cohort. 18 The most widely used prognostic model is the King's college criteria (Table 2). However, in Indian situation, its relevance is questionable.…”

Section: Role Of Ammoniamentioning

confidence: 99%

Management in Acute Liver Failure

Shalimar

Acharya

2015

Journal of Clinical and Experimental Hepatology

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Acute liver failure (ALF) is a rare, potentially fatal complication of severe hepatic illness resulting from various causes. In a clinical setting, severe hepatic injury is usually recognised by the appearance of jaundice, encephalopathy and coagulopathy. The central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a central role in the pathogenesis. The role of newer ammonia lowering agents is still evolving. Liver transplant is the only effective therapy that has been identified to be of promise in those with poor prognostic factors, whereas in the others, aggressive intensive medical management has been documented to salvage a substantial proportion of patients. A small fraction of patients undergo liver transplant and the remaining are usually treated with medical therapy. Therefore, identification of the complications and causes of death in such patients, and use of appropriate prognostic models to identify those who need liver transplant and those who can be managed with medical treatment is a vital component of therapeutic strategy. In this review, we discuss the various pathogenetic mechanisms and treatment options available. ( J CLIN EXP HEPATOL 2015;5:S104-S115)A cute liver failure (ALF) can be a fatal complication of acute hepatic injury and occurs unpredictably. It is a rare clinical entity marked by the sudden loss of hepatic function and a severe life-threatening course in a person with no prior history of liver disease. ALF represents a syndrome rather than a specific disease, having multiple causes that vary in course and outcome. ALF is difficult to identify in its early stages, resulting in frequent delays in initiation of treatment. The causes of ALF include viral hepatitis, drug induced and toxin-induced liver damage, metabolic errors, ischemia, and miscellaneous rare causes.ALF is defined by three criteria: (1) rapid development of hepatocellular dysfunction (jaundice, coagulopathy), (2) encephalopathy, and (3) absence of a prior history of liver disease. 1 However, the interval between onset of acute hepatic injury (jaundice) and onset of liver failure (encephalopathy with or without coagulopathy) in such patients (icterus-encephalopathy interval; IEI) has been described to be between 4 weeks (Indian definition) 2-4 to 24 weeks (AASLD-ALF study group). 5 Further, due to the diverse natural course, ALF has been sub-classified as hyperacute (IEI # 7 day), acute (IEI # 4 weeks) and sub-acute ALF (IEI $ 5 week to #12 weeks) by British authors. 6 Despite these differences in definitions, the central and most important clinical event in ALF is occurrence of hepatic encephalopathy (HE) and cerebral edema which is responsible for most of the fatalities in this serious clinical syndrome. The pathogenesis of encephalopathy and cerebral edema in ALF is unique an...

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“…25 ALF is a dynamic process in which variables determining prognosis at admission change over time, and thus the clinical course varies accordingly. A new prognostic model from India, ALF early dynamic (ALFED) model 91 is based on four variables: arterial ammonia, serum bilirubin, international normalized ratio and hepatic encephalopathy > grade II. This model takes into account the values of these variables over 3 days.…”

Section: Prognostic Modelsmentioning

confidence: 99%

Hepatitis E and Acute Liver Failure in Pregnancy

Shalimar

Acharya

2013

Journal of Clinical and Experimental Hepatology

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Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure

Abstract: The ALFED model accurately predicted outcome in patients with ALF, which may be useful in clinical decision-making.

Cited by 95 publications

References 39 publications

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

Management in Acute Liver Failure

Hepatitis E and Acute Liver Failure in Pregnancy

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