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The Natural History of Severe Acute Liver Injury

Authors :
Steven-Huy B. Han
Iris Liou
Constantine J. Karvellas
K.R. Reddy
William M. Lee
Adrian Reuben
Jaime L. Speiser
Averell H. Sherker
Ram Subramanian
Timothy Davern
Anne M. Larson
Richard T. Stravitz
Natalie Murray
A. J. Hanje
Santiago J. Munoz
R.T. Chung
Lorenzo Rossaro
Raj Satyanarayana
Valerie Durkalski
R. S. Brown
Bilal Hameed
David G. Koch
Atif Zaman
Jody C. Olson
Oren K. Fix
Obaid S. Shaikh
Daniel Ganger
Michael L. Schilsky
Robert J. Fontana
Brendan M. McGuire
J. E. Hay
Timothy M. McCashland
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.

Details

ISSN :
15720241
Volume :
112
Issue :
9
Database :
OpenAIRE
Journal :
The American journal of gastroenterology
Accession number :
edsair.doi.dedup.....227ef34be21ff3561f1f4a6609243bbb