Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

McPhail, Mark; Farne, Hugo; Senvar, Naz; Wendon, Julia; Bernal, William

doi:10.1016/j.cgh.2015.10.007

Cited by 123 publications

(100 citation statements)

References 54 publications

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“…Nevertheless, use of the KCC did not show any association with hospital mortality in our cohort. In fact, the KCC have been shown to lack good sensitivity (58%) for predicting hospital mortality from non-paracetamol-related ALF [15, 16]. Furthermore, while these patients benefit more from LT than do patients with paracetamol overdosage, the likelihood of death is much higher if an organ is not timely available or if there are contraindications to LT (e.g., ongoing sepsis, psychiatric disorder, and malignancy).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

Simões

Santos

Vicente

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Acute liver failure (ALF) is a rare disease with potentially high mortality rates. We aimed to study the recent epidemiology of ALF in one of the Portuguese liver transplant (LT) regions. Methods: We assessed a retrospective cohort including 34 consecutive patients with ALF admitted to the intensive care unit (ICU) of Curry Cabral Hospital (Lisbon, Portugal) between October 2013 and December 2016. Results: The median age (IQR) was 49 (31–67) years, and 21 (62%) of the cohort were female. Non-paracetamol etiologies were found in 29 patients (85%). On ICU admission, grade 3–4 hepatic encephalopathy developed in 10 patients (29%); invasive mechanical ventilation, vasopressors, and renal replacement therapy were required for 8 (24%), 7 (21%), and 5 (15%) of the patients, respectively; the King’s College criteria (KCC) were fulfilled by 16 patients (47%). Of the 15 (44%) nontransplanted patients, 11 (73%) died during their hospital stay. Of the 19 (56%) transplanted patients, 4 (21%) died during their hospital stay. KCC were not associated with hospital mortality (p = 0.97), but they were significantly associated with LT (p = 0.008). Conclusions: In a Portuguese cohort of patients with ALF, non-paracetamol etiologies were predominant. Hospital mortality was much lower amongst transplanted patients.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

Simões

Santos

Vicente

et al. 2018

GE Port J Gastroenterol

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“…The predictive value of MELD and mechanical ventilation quantified in the final model reinforces the argument that the severity of hepatic failure (INR and bilirubin as part of MELD) and extra-hepatic organ failures, namely renal (creatinine as part of MELD), respiratory and neurological (mechanical ventilation may have been needed both for respiratory failure per se or due to coma) failures, are likely crucial for the short-term prognosis of patients with HBV-associated ALF. Two recent publications have emphasized the good prognostic ability of MELD in the setting of non-acetaminophen ALF 16, 26 …”

Section: Discussionmentioning

confidence: 99%

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Karvellas

Cardoso

Gottfried

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims: Acute liver failure (ALF) due to hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune suppressive therapy, compared to patients with HBV-associated ALF without immunosuppression (controls). Methods: We performed a retrospective multi-center study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade of hepatic encephalopathy, model for end-stage liver disease (MELD) score, and King’s College criteria. We also collected data on clinical features, medical therapies, and complications in the first 7 days following study enrollment. Logistic regression was used to identify factors associated with transplant-free survival 21 days in HBV-associated ALF (the primary outcome). Results: Among patients with HBV-associated ALF, 28 cases (18%) occurred after immunosuppressive therapy (15 patients received systemic corticosteroids and 21 received chemotherapy); and 128 cases did not (controls, 82%). Significantly greater proportions of patients with Hepatitis B-associated ALF after immunosuppression were non-white, and had anemia or thrombocytopenic than controls (P<.02 for all). The serologic profile of HBV infection, severity of liver failure (based on MELD score), and complications (hepatic encephalopathy or need for mechanical ventilation, vasopressors, or renal replacement therapy) were similar between the groups (P>.17 for all). Significantly smaller proportions of patients with ALF after immunosuppression than controls survived for 21 days (42.9% vs 62.5% of controls; P=.0096). Factors associated with 21 day transplant-free survival (c-statistic = 0.866) were increased MELD score (odds ratio, 0.894 per increment), requirement for mechanical ventilation (odds ratio, 0.111), and immunosuppressive therapy (odds ratio, 0.274). Conclusion: Within a cohort study of HBV-associated ALF patients, 18% had received immunosuppressive therapy. Significantly smaller proportions of HBV-associated ALF patients after immunosuppression survive beyond 21 days than patients with HBV-associated ALF who did not receive immunosuppression. Patients undergoing chemotherapy should be screened for HBV infection and given appropriate anti-viral therapies to reduce preventable mortality.

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“…The metabolic acidosis also gradually improved over the course of SPAD treatment and normalized after 24 h (pH 7.45, bicarbonate 28 mmol/L). Urgent liver transplantation was recommended as the patient suffered from fulminant hepatic failure with hematological and biochemical parameters that were associated with a high risk of mortality based on the modified King’s College Criteria (INR 3.7, PTT 51 s, conjugated bilirubin 691 µmol/L, unconjugated bilirubin 115 µmol/L) [15]. He underwent successful liver transplantation on day 6.…”

Section: Case Reportsmentioning

confidence: 99%

Single Pass Albumin Dialysis and Plasma Exchange for Copper Toxicity in Acute Wilson Disease

Bakhsh

Teoh

Harvey

et al. 2019

Case Rep Nephrol Dial

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Background: Wilson disease (WD) is a disorder of copper metabolism that results in accumulation of copper in tissues. In acute WD, patients present with fulminant hepatic failure, encephalopathy, and hemolytic anemia due to copper release from necrotic hepatocytes. Many will require life-saving liver transplantation. Extracorporeal liver support systems can provide a bridge to transplantation for critically ill patients. We report our experience with 2 patients for whom we used a combination of plasma exchange (PLEX) and single pass albumin dialysis (SPAD), or SPAD alone as a bridge to liver transplantation. Case Reports: A 17-year-old girl (patient 1) and a 12-year-old boy (patient 2) presented with fulminant hepatic failure, hemolytic anemia, and acute kidney injury. Patient 1 received SPAD on days 2 and 3 (total 32 h). Serum copper decreased from 22.3 to 15.9 µmol/L (28.7% decrease), measured after 28 h of continuous SPAD. She underwent successful liver transplantation on day 4 after presentation. Patient 2 was treated with PLEX on days 1, 3, 4, and 5 and with SPAD on days 3–6. Serum copper decreased from 48.7 to 25.8 µmol/L (47% decrease) after the first session of PLEX and from 35.5 to 21.5 µmol/L (39.4% decrease) after the second session. The serum copper level was 16.2 µmol/L after 4 sessions of PLEX (and ongoing SPAD), with an overall 66.7% reduction in copper levels over 5 days combining both therapies. He underwent successful liver transplantation on day 6. Conclusion: We conclude that SPAD, with or without PLEX, is effective in reducing serum copper levels as a bridge to liver transplantation in WD. PLEX may be more efficient at removing copper but is associated with a rebound increase in copper levels between sessions.

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Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

Cited by 123 publications

References 54 publications

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Single Pass Albumin Dialysis and Plasma Exchange for Copper Toxicity in Acute Wilson Disease

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