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The Natural History of Severe Acute Liver Injury
- Source :
- The American journal of gastroenterology. 112(9)
- Publication Year :
- 2016
-
Abstract
- Acute liver failure (ALF) is classically defined by coagulopathy and hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe acute hepatocyte necrosis without HE, has not been carefully defined nor studied. Our aim is to describe the clinical course of specifically defined ALI, including the risk and clinical predictors of poor outcomes, namely progression to ALF, the need for liver transplantation (LT) and death.386 subjects prospectively enrolled in the Acute Liver Failure Study Group registry between 1 September 2008 through 25 October 2013, met criteria for ALI: International Normalized Ratio (INR)≥2.0 and alanine aminotransferase (ALT)≥10 × elevated (irrespective of bilirubin level) for acetaminophen (N-acetyl-p-aminophenol, APAP) ALI, or INR≥2.0, ALT≥10x elevated, and bilirubin≥3.0 mg/dl for non-APAP ALI, both groups without any discernible HE. Subjects who progressed to poor outcomes (ALF, death, LT) were compared, by univariate analysis, with those who recovered. A model to predict poor outcome was developed using the random forest (RF) procedure.Progression to a poor outcome occurred in 90/386 (23%), primarily in non-APAP (71/179, 40%) vs. only 14/194 (7.2%) in APAP patients comprising 52% of all cases (13 cases did not have an etiology assigned; 5 of whom had a poor outcome). Of 82 variables entered into the RF procedure: etiology, bilirubin, INR, APAP level and duration of jaundice were the most predictive of progression to ALF, LT, or death.A majority of ALI cases are due to APAP, 93% of whom will improve rapidly and fully recover, while non-APAP patients have a far greater risk of poor outcome and should be targeted for early referral to a liver transplant center.
- Subjects :
- 0301 basic medicine
Adult
Male
medicine.medical_specialty
Gastroenterology
Severity of Illness Index
Article
03 medical and health sciences
0302 clinical medicine
Internal medicine
Severity of illness
medicine
Coagulopathy
Adverse Drug Reaction Reporting Systems
Humans
International Normalized Ratio
Registries
Hepatic encephalopathy
Acute liver injury
Hepatology
biology
business.industry
Clinical course
Alanine Transaminase
Middle Aged
medicine.disease
Prognosis
United States
Natural history
030104 developmental biology
Alanine transaminase
Hepatocyte necrosis
Data Interpretation, Statistical
Hepatic Encephalopathy
biology.protein
030211 gastroenterology & hepatology
Female
Chemical and Drug Induced Liver Injury
business
Subjects
Details
- ISSN :
- 15720241
- Volume :
- 112
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- The American journal of gastroenterology
- Accession number :
- edsair.doi.dedup.....227ef34be21ff3561f1f4a6609243bbb