Acute liver failure

Slack, Andy; Wendon, Julia

doi:10.7861/clinmedicine.11-3-254

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…NAC was administered as a continuous infusion in 3 studies, while in the other 3 studies a loading dose was given prior to the continuous infusion [ 4 ]. A systematic review comparing oral with intravenous NAC administration showed similar levels of hepatotoxicity in rats with acetaminophen overdose, and the route of dosing did not make much difference [ 17 ]. NAC is a well-tolerated drug and has a low adverse effect profile.…”

Section: Discussionmentioning

confidence: 99%

Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review

Walayat¹,

Shoaib

Asghar

et al. 2021

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Background The American Association for the Study of Liver Diseases recommends that N-acetylcysteine (NAC) may be beneficial in non-acetaminophen-related drug-induced liver injury. A subsequent review and analysis reported the current evidence to be inconclusive. Herein, we present an updated review and meta-analysis. Methods We evaluated prospective, retrospective and randomized controlled trials that compared outcomes in patients of all ages with acute liver failure (defined as abnormal liver enzymes along with elevated international normalized ratio >1.5, with or without hepatic encephalopathy) receiving NAC with the outcomes in a control group. The primary outcome was to compare the overall survival in the 2 groups. Secondary outcomes included difference in length of hospital stay, transplant-free survival, and post-transplant survival. Results Seven studies (N=883) that met the inclusion criteria were included in this analysis. The mean age of patients in the NAC group was 21.22 years compared with 23.62 years in the control group. The odds of overall survival were significantly higher in the NAC group than in controls (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.3-2.41). Post-transplant survival (OR 2.44, 95%CI 1.11-5.37) and transplant-free survival were also better in the NAC group than in the control group (OR 2.85, 95%CI 2.11-3.85). Patients in the control group had statistically significant odds of a longer inpatient stay (mean difference 7.79, 95%CI 6.93-8.66). Conclusion In patients with non-acetaminophen-related acute liver failure, NAC significantly improves overall survival, post-transplant survival and transplant-free survival while decreasing the overall length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review

Walayat¹,

Shoaib

Asghar

et al. 2021

aog

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“…Основными причинами летальности при ОПН являются отёк мозга с последующим вклинением ствола головного мозга, желудочно-кишечные кровотечения, инфекционные осложнения и полиорганная недостаточность [32]. У 70-80 % больных с ОПН, находившихся в коматозном состоянии, при аутопсии обнаруживается вклинение ствола мозга или мозжечка [40]. Пациенты с ОПН подвержены как бактериальной, так и грибковой (кандидозной) инфекции.…”

Section: прогноз и исходы острой печёночной недостаточностиunclassified

Current Approach to Diagnosis and Treatment for Liver Failure (Literature Review)

Плеханов¹,

Plekhanov²,

Товаршинов³

et al. 2016

Бюллетень Восточно-Сибирского Научного Центра Сибирского Отделения Российской Академии Медицинских Наук

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Currently, the world is marked rise in the number of patients with liver disease. Approximately 100,000 patients hepatitis complicated by acute liver failure, with mortality in this disease reaches 70-90% despite the use of modern methods of treatment Currently, there are more than 20 concepts of this disease. In 15-20% of cases the cause of acute liver failure can not be established. Most clinicians believe that the pathogenesis of liver failure is a strong humoral and hyperimmune response, resulting in massive necrosis of liver cells. Diagnosis of liver failure based on anamnesis, clinical, biochemical and electroencephalographic changes. Traditional conservative therapy of acute liver failure in the first place based on the measures taken to address the etiological factor. Transplantation is an effective measure in acute liver failure. In the world there are a sufficient number of prognostic scales, criteria and risk factors of acute liver failure. Each of them has its own characteristics, but a unified system of prognostic estimation of arrester.

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“…The static tests such as model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores quantify liver functions to assess the extent and severity of liver cirrhosis, and predict the prognosis and mortality before TIPS or liver transplantation [7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of residual hepatic reserve and hepatic decompensation in cirrhotic patients after ablated hepatocellular carcinoma treated by DDAs or systemic therapy

Hanafy

Mohamed

Taleb

et al. 2021

Egypt Liver Journal

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Background Therapeutic interventions for hepatocellular carcinoma (HCC) particularly in patients with advanced liver disease may lead to more aggravation of clinical and biochemical parameters of liver functions. We aimed to assess the utilization of easily applied variables which evaluate residual hepatic reserve to predict liability for complications and hepatic decompensation in cirrhotic patients with ablated HCC particularly when these patients were exposed to specific medical treatment such as DAAs and systemic therapy for HCC such as sorafenib. This study included 3 groups with HCC. Group 1: patients with ablated HCC and Child-Turcotte-Pugh (CTP) class A, who received Sofosbuvir (SOF)-based treatment (n = 250), group 2: HCC patients CTP (A), managed with sorafenib after transarterial chemoembolization (TACE) (n = 250) and group 3 as a control group of non-cirrhotic patients (n = 176). Evaluation for all patients was done by routine laboratory investigations including liver and kidney functions, complete blood count, platelet indices and plasma ammonia, upper gastrointestinal (GI) endoscopy and estimation of liver volume by ultrasound and liver stiffness (LS) by Fibroscan. Results Unfavorable outcome and increased incidence of complications during DAAs were independently associated with severity of thrombocytopenia (p = 0.001) at a cut-off 78,000/μl, LS > 20 kPa (p = 0.001), liver volume < 500 ml (p = 0.002), and gamma globulin levels > 4 gm/dl (p = 0.004). In the sorafenib group, unfavorable outcome and complications were independently associated with PDW/MPV ratio > 2.74 (p = 0.001), level of ammonia > 87 μg/dl (p = 0.001), LS > 25 kPa (p = 0.001), and liver volume < 490 ml (p = 0.001). Conclusion Non-invasive parameters of residual hepatic reserve are promising tools to guide therapy and avoid further complications in patients with liver cirrhosis and ablated HCC.

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Acute liver failure

Cited by 4 publications

References 16 publications

Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review

Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: an updated meta-analysis and systematic review

Current Approach to Diagnosis and Treatment for Liver Failure (Literature Review)

Predictors of residual hepatic reserve and hepatic decompensation in cirrhotic patients after ablated hepatocellular carcinoma treated by DDAs or systemic therapy

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