A 20-year single-center experience with acute liver failure during pregnancy: Is the prognosis really worse?

Bhatia, Vikram; Singhal, Amit; Panda, Subrat Kumar; Acharya, Subrat Kumar

doi:10.1002/hep.22493

Cited by 185 publications

(153 citation statements)

References 33 publications

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“…In ALF, rapid immune paralysis is well known and overt sepsis has been reported in 55%-90% of patients. 19 A strong association between occurrence of infection and course of encephalopathy has been clearly documented. 3,20 In a prospective evaluation of 96 acetaminophen induced ALF cases with early encephalopathy, occurrence of infection was associated with progression of encephalopathy to deeper grades in about 80% of the individuals.…”

Section: Infections and Systemic Inflammatory Response Syndrome (Sirsmentioning

confidence: 98%

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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Section: Infections and Systemic Inflammatory Response Syndrome (Sirsmentioning

confidence: 98%

Management in Acute Liver Failure

Shalimar

Acharya

2015

Journal of Clinical and Experimental Hepatology

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“…Indian epidemics of hepatitis E virus have shown that pregnant women especially in their second and third trimesters get infected more frequently (12-20%) than men and non-pregnant women (2-4%) for unclear reasons. 18 Even the mortality rate is significantly higher among pregnant women who develop hepatitis during epidemics (10-39%) than in the general population affected with hepatitis (0.06-12%). In the sporadic setting, evidence of HEV infection has been detected in 30-45% of patients with ALF.…”

Section: Acute and Subacute Liver Failurementioning

confidence: 99%

“…One study found that progesterone receptor gene mutations (PROGINS) occur more frequently among pregnant female patients with ALF and these patients also had high viral load leading to poor pregnancy outcomes in hepatitis E. 19 Once the pregnant females develop ALF, mortality is similar to that of non-pregnant women and men with ALF, and is independent of the cause or trimester. 18 Acute Fatty Liver of Pregnancy is related to genetic predisposition, and may also have geographical variation in prevalence.…”

Section: Acute and Subacute Liver Failurementioning

confidence: 99%

“…The other causes associated with increased incidence of renal failure include amanita poisoning and trimethoprim-sulfamethoxazole toxicity. 18 In Indian subcontinent, where viral hepatitis is the common etiology, renal failure has been reported in 10% of patients. 20 In India, 58% of ALF patients have cerebral edema at the time of hospitalization.…”

Section: Acute and Subacute Liver Failurementioning

confidence: 99%

“…In recent reports, the predominant organisms reported are Gram negative. 18,30 There are several non-hepatotropic viruses that can also lead to similar syndrome. One example is Yellow fever, which is caused by a virus carried by mosquitoes.…”

Section: Acute and Subacute Liver Failurementioning

confidence: 99%

See 2 more Smart Citations

Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

Anand

Garg

2015

Journal of Clinical and Experimental Hepatology

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Hepatitis E Virus

Lhomme

Abravanel

Chapuy‐Regaud

et al. 2015

Encyclopedia of Life Sciences

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The hepatitis E virus (HEV) infection is a worldwide disease. HEV is usually responsible of an acute self‐limiting infection, but pregnant women and patients with preexisting liver disease can suffer from severe forms. HEV infections can lead to chronic hepatitis and cirrhosis in immunocompromised patients. Extrahepatic manifestations can also occur. In developing countries, HEV is transmitted via contaminated water. In developed countries, transmission is zoonotic due to consumption of uncooked or undercooked infected meat and direct contact with infected animals. Transfusion‐transmitted HEV infections were also described. HEV infections are diagnosed by detecting anti‐HEV antibodies in the serum. In immunocompromised patients, detecting HEV RNA in the blood or faeces is needed. A 3‐month course of ribavirin is effective for treating chronic infection: a sustained virologic response occurs in 78% of patients. Vaccine has been recently licensed for use in China and provides protection against hepatitis E for up to 4.5 years. Key Concepts The hepatitis E virus infection is a worldwide disease. Animal reservoir is responsible for autochthonous HEV infection in developed countries. Chronic infections are possible in immunocompromised patients. Treatment of choice for chronic HEV infections is a 3‐month course of ribavirin. Vaccine afforded a sustained protection.

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A 20-year single-center experience with acute liver failure during pregnancy: Is the prognosis really worse?

Cited by 185 publications

References 33 publications

Management in Acute Liver Failure

Management in Acute Liver Failure

Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

Hepatitis E Virus

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