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Background & Aims: Severe acute liver injury (ALI) precedes acute liver failure (ALF). Risk factors related to ALI progression to ALF or death, are not well-known. We aimed to investigate which predictors of poor outcomes can be identified in patients with ALI.
Methods: We retrospectively analyzed 59 patients with ALI diagnosis, admitted from 2010 to 2021 in our Intermediate Medical Care Unit, and checked for clinical, biochemical and imagiological data, in order to explore their relationship with progression to ALF or death.
Results: From the 59 patients with ALI, 11 (18.6%) evolved to ALF and 9 (15.3%) died during the hospital staying or within the first month after discharge. Not having drug-induced liver injury or ischemic hepatitis as etiological factors was associated to increased progression to ALF (hazard ratio [HR] 0.17; 95% confidence interval [CI]: 0.03-0.96; P=0.041). In univariate analysis, ascites related to development to ALF (HR 0.25; 95% CI: 0.06-0.97; P=0.037) and death (HR 7.09; 95% CI: 1.55-33.04; P=0.006), while renal dysfunction, was only allied to death (HR 0.99; 95% CI: 0.97-1.00; P=0.035). Inflammatory markers at admission were not linked to progression to ALF. Yet, increased C reactive-protein levels were commonly found in patients who died (HR 1.01; 95% CI: 1.00-1.03; P=0.035). In multivariate analysis, only ascites remained significant (P=0.005) as predictor of death.
Conclusions: In patients with ALI, ascites at presentation is the only marker of poor prognosis (mainly to death). Still, those who are more inflamed or have renal dysfunction at baseline are more willing to die.
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2. Areia M, Romaozinho JM, Ferreira M, Amaro P, Leitao MC. Fulminant hepatic failure: a Portuguese experience. Eur J Gastroenterol Hepatol. 2007;19(8):665-669.
3. Cardoso FS, Marcelino P, Bagulho L, Karvellas CJ. Acute liver failure: An up-to-date approach. J Crit Care. 2017;39:25-30.
4. Germani G, Theocharidou E, Adam R, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol. 2012;57(2):288-296.
5. Rovegno M, Vera M, Ruiz A, Benitez C. Current concepts in acute liver failure. Ann Hepatol. 2019;18(4):543-552.
6. O'Grady J. Timing and benefit of liver transplantation in acute liver failure. J Hepatol. 2014;60(3):663-670.
7. Elinav E, Ben-Dov I, Hai-Am E, Ackerman Z, Ofran Y. The predictive value of admission and follow up factor V and VII levels in patients with acute hepatitis and coagulopathy. J Hepatol. 2005;42(1):82-86.
8. Vaquero J, Polson J, Chung C, et al. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 2003;125(3):755-764.
9. Koch DG, Speiser JL, Durkalski V, et al. The Natural History of Severe Acute Liver Injury. Am J Gastroenterol. 2017;112(9):1389-1396.
10. Francque S, Vonghia L, Ramon A, Michielsen P. Epidemiology and treatment of autoimmune hepatitis. Hepat Med. 2012;4:1-10.
11. Sahebjam F, Vierling JM. Autoimmune hepatitis. Front Med. 2015;9(2):187-219.
12. Amacher DE. Female gender as a susceptibility factor for drug-induced liver injury. Hum Exp Toxicol. 2014;33(9):928-939.
13. Castiella A, Zapata E, Lucena MI, Andrade RJ. Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease. World J Hepatol. 2014;6(4):160-168.
14. Simoes C, Santos S, Vicente M, Sousa Cardoso F. Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal. GE Port J Gastroenterol. 2018;26(1):33-39.
15. Marrone G, Vaccaro FG, Biolato M, et al. Drug-induced liver injury 2017: the diagnosis is not easy but always to keep in mind. Eur Rev Med Pharmacol Sci. 2017;21(1 Suppl):122-134.
16. Tyagi A, Pruthi HS. Ischemic Hepatitis. Med J Armed Forces India. 1999;55(4):359-360.
17. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137(12):947-954.
18. Escorsell A, Mas A, de la Mata M, Spanish Group for the Study of Acute Liver Failure. Acute liver failure in Spain: analysis of 267 cases. Liver Transpl. 2007;13(10):1389-1395.
19. Hadem J, Tacke F, Bruns T, et al. Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol. 2012;10(6):664-669 e662.
20. Kayaalp C, Ersan V, Yilmaz S. Acute liver failure in Turkey: a systematic review. Turk J Gastroenterol. 2014;25(1):35-40.
21. Takahashi A, Ohira H, Abe K, et al. Increasing incidence of acute autoimmune hepatitis: a nationwide survey in Japan. Sci Rep. 2020;10(1):14250.
22. Schramm C, Lohse AW. Autoimmune hepatitis on the rise. J Hepatol. 2014;60(3):478-479.
23. Navasa M, Garcia-Pagan JC, Bosch J, et al. Portal hypertension in acute liver failure. Gut. 1992;33(7):965-968.
24. Valla D, Flejou JF, Lebrec D, et al. Portal hypertension and ascites in acute hepatitis: clinical, hemodynamic and histological correlations. Hepatology. 1989;10(4):482-487.
25. Lee WM, Hynan LS, Rossaro L, et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009;137(3):856-864, 864 e851.
26. McPhail MJ. Improving MELD for use in acute liver failure. J Hepatol. 2011;54(6):1320; author reply 1320-1321.
27. Wigmore SJ, Walsh TS, Lee A, Ross JA. Pro-inflammatory cytokine release and mediation of the acute phase protein response in fulminant hepatic failure. Intensive Care Med. 1998;24(3):224-229.