Acute liver failure in Spain: Analysis of 267 cases

Abstract

The cause of acute liver failure (ALF) is a major determinant of its outcome. Acetaminophen (paracetamol) overdose is a leading cause of ALF in some developed countries, whereas in others, such as Spain, it is extremely rare. To analyze the etiology, characteristics, and outcome of ALF in Spain, we performed a retrospective analysis of 267 patients whom we observed from 1992 to 2000. Seventeen tertiary-care hospitals with active liver transplantation (LT) programs contributed data. Causes of ALF were viral hepatitis in 98 (37%; hepatitis B virus in 75 patients), unknown in 86 (32%), drug or toxic reactions in 52 (19.5%; acetaminophen overdose in 6), and miscellaneous in 31 (11.6%). Overall survival was 58%. LT was performed in 150 patients, with a survival of 69%. Despite fulfilling criteria, 51 patients were not transplanted because of contraindications; their survival was only 7.8%. Forty-seven (85.5%) of 55 patients without transplant criteria survived. Hepatitis B virus is the most common cause of ALF in Spain, although the origin of 30% of cases remains undetermined. Acetaminophen overdose represents a very rare cause of ALF. LT was performed in Ͼ50% of cases. Patients without transplant criteria had a very good prognosis; those who fulfilled these criteria but who had contraindications for transplantation had a high mortality rate. Liver Transpl 13:1389Transpl 13: -1395Transpl 13: , 2007

Acute Liver Failure, Etiology, and Outcome: An Experience in a Referral Liver Transplant Center

“…Median of the time to event was shorter in patients who did not survive, emphasizing the need for more rapid action in patients with more severe disease. The median time to transplantation was 9 days in our study, which was considerably longer compared to similar reports (11,17).…”

“…In a study conducted by Gulmez et al it was found that acute drug overdose, mainly from acetaminophen, was the etiology for ALF in 20% of the causes in 7 European countries overall, but with a very variable range of prevalence from 1% in Italy to 52% in Ireland (16). In another study by Escorsell et al the incidence of acetaminophen induced ALF was reported to be very low (2.2%) in Spain (17).…”

“…This high rate of HAV-induced ALF is not a usual finding in other parts of the world. In a study from Spain, viral hepatitis from acute hepatitis B is recognized as the most common cause of ALF, accounting for 37% of the cases (17). Acute hepatitis E has been reported as the most common cause of ALF in India by Khuroo et al with a high incidence rate in pregnant patients.…”

Point-of-care continuous13C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

“…Patients that fulfilled the criteria, but were not provided transplants due to contraindications, had a survival rate of only 7.8%. Those that did not fulfill the transplant criteria had a 85.5% survival rate [45] . The high survival rate in our group of patients might be explained by the fact that only 2 patients (13%) fulfilled the transplant criteria.…”

Hypothermia in Acute Liver Failure

“…However this data is predominantly from developed countries, data from developing countries where the etiology of ALF is very different is virtually absent. The most common etiologies in the developing world are hepatotrophic viruses (Hepatitis A, B and E) in comparison to drug induced liver failure which predominates in developed countries [2]. Amongst drugs, acetaminophen is the leading cause of acute liver failure and accounts for approximately 50% of the cases in the US [3].…”