The incidence, etiologies, outcomes, and predictors of mortality of acute liver failure in Thailand: a population-base study

Abstract

BackgroundAcute liver failure (ALF) is uncommon but progresses rapidly with high mortality. We investigated the incidence, etiologies, outcomes, and predictive factors for 30-day mortality in patients with ALF.MethodsWe conducted a population-based study of ALF patients hospitalized between 2009 and 2013 from the Thai Nationwide Hospital Admission database, which comprises 76% of all admissions from 858 hospitals across 77 provinces in Thailand. ALF was diagnosed using ICD-10 codes K72.0 and K71.11. Patients with liver cirrhosis were excluded.ResultsThere were 20,589 patients diagnosed with ALF during the study period with 12,277 (59.6%) males and mean age of 46.6 ± 20.7 years. The incidence of ALF was 62.9 per million population per year. The most frequent causes of ALF were indeterminate (69.4%), non-acetaminophen drug-induced (26.1%), and viral hepatitis (2.5%). Acetaminophen was the presumptive cause in 1.7% of patients. There were 5502 patients (26.7%) who died within 30 days after admission. One patient (0.005%) underwent liver transplantation. The average hospital stay was 8.7 ± 13.9 days, and the total cost of management was 1075.2 ± 2718.9 USD per admission. The most prevalent complications were acute renal failure (ARF)(24.2%), septicemia (18.2%), and pneumonia (12.3%). The most influential predictive factors for 30-day mortality were ARF (HR = 3.64, 95% CI: 3.43–3.87, p < 0.001), malignant infiltration of the liver (HR = 3.37, 95% CI: 2.94–3.85, p < 0.001), and septicemia (HR = 1.96, 95%CI: 1.84–2.08, p < 0.001).ConclusionsALF patients have poor outcomes with 30-day mortality of 26.7% and high economic burden. Indeterminate etiology is the most frequent cause. ARF, malignant infiltration of the liver, and septicemia are main predictors of 30-day mortality.

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Transplantation of bone mesenchymal stem cells effectively promotes intestine regeneration to eliminate endotoxemia and reduce mortality in the animal model of acute liver failure

“…Then, after con rming the appropriate dose of modeling, we transplanted BMSCs to rats with liver failure, rats were divided into 3 groups: saline, TAA + saline, and TAA + saline + BMSCs (1×10 6 , intravenous injection). To collect samples, all rats were sacri ced by CO 2 asphyxiation.…”

“…Acute liver failure is characterized by sudden development of liver dysfunction and rapid hepatocellular necrosis, may progress to exhibit hepatic coma even death due to various of etiologies, including drug toxicity, hepatic ischemia, immune-mediated attack, and viral hepatitis such as hepatitis B and hepatitis C [1,2]. Endotoxemia represents the severe stage of acute liver failure and is associated with poor quality of life, mortality, and economic burden [3].…”