Acute Liver Failure

Canbay, Ali; Tacke, Frank; Hadem, Johannes; Trautwein, Christian; Gerken, Guido; Manns, Michael P.

doi:10.3238/arztebl.2011.0714

Cited by 47 publications

(38 citation statements)

References 42 publications

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“…In this study, all patients had high levels of serum cell death markers [6]. No differences were observed between ALF and non-ALF or within the subgroups of ALF, which may be due to a limitation in sample size or unequal distribution of patient numbers into the different groups.…”

Section: Discussionmentioning

confidence: 99%

“…For those needing a transplant, another decision has to be made on the patient's eligibility for high-urgency listing. Although the KCC, MELD, and Clichy criteria are recognized scoring systems used to identify patients who will require a liver transplant (i.e., ability to predict death), they all lack the specificity and accuracy in predicting survival [6]. …”

Section: Discussionmentioning

confidence: 99%

“…All patients presented with ALF according to the criteria established by the German Acute Liver Study Group within 4 weeks of symptom onset and without apparent or known preexisting liver disease on admission [6]. A reference (control) group with 10 patients was included.…”

Section: Methodsmentioning

confidence: 99%

“…However, the differentiation between ALF, acute-on-chronic liver failure and acute-on-cirrhotic liver failure may, at times, be more complex [6]. The presence or absence of underlying chronic liver disease is important, and impacts on prognosis and treatment, including the fulfillment for high-urgency liver transplantation (the presence of chronic disease would preclude a patient from being considered for high-urgency liver transplant).…”

Section: Introductionmentioning

confidence: 99%

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Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Dechêne¹,

Sowa²,

Schlattjan³

et al. 2014

Digestion

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Background/Aims: For diagnosis, prognosis, and treatment of acute liver failure (ALF), macroscopic evaluation and histological assessment of the liver are important. Due to impaired coagulation in ALF, the risk of bleeding is high after a percutaneous liver biopsy. Our aims were to assess (i) safety and benefit of mini laparoscopy (ML) in patients with ALF and (ii) the potential utility of histological markers in ALF prognosis. Methods: ML was performed in 39 patients with ALF to assess liver surface and to obtain a liver biopsy. Serological markers of liver injury and immunohistochemical detection of cell death and proliferation were compared to a non-ALF group (n = 10). Results: Liver biopsies were successfully performed in all patients with no significant complications. All patients had markedly elevated M30 and M65 levels in the serum. In the liver, M30 and Ki67 immune-reactive cells were more abundant in those with ALF. Importantly, there were significantly more Ki67-positive cells but fewer M30-positive cells in livers of ALF patients who recovered spontaneously. Conclusion: ML with liver biopsy in patients with ALF and severe coagulopathy is safe. Immunohistochemical detection of liver cell death and regeneration may identify individuals who would recover spontaneously or who would need a liver transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Dechêne¹,

Sowa²,

Schlattjan³

et al. 2014

Digestion

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“…The causes of ALF are heterogeneous and may vary from country to country. Traditionally, hepatitis B was regarded as the most common cause of ALF [6]. Over the last decade, statistics suggest a change in ALF etiology in developed countries.…”

Section: Causes and Epidemiologymentioning

confidence: 99%

Liver Failure due to Acute Viral Hepatitis (A-E)

et al. 2016

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Background: Viral hepatitis is still one of the key causes of acute liver failure (ALF) in the world. Methods: A selective literature search of the PubMed database was conducted, including current studies, reviews, meta-analyses, and guidelines. We obtained an overview of ALF due to viral hepatitis in terms of epidemiology, course, and treatment options. Results: Most fulminant viral courses are reported after infection with hepatitis A, B, and B/D, but not with hepatitis C. Hepatitis E is also known to cause ALF but has not gained much attention in recent years. However, more and more autochthonous hepatitis E virus infections have been recently observed in Europe. Reactivation of hepatitis B virus (HBV) under immunosuppressive conditions, such as after intensive chemotherapy, is also an increasing problem. For most viral-induced cases of ALF, liver transplantation represented the only therapeutic option in the past. Today, immediate treatment of HBV-induced ALF with nucleotide or nucleoside analogs is well tolerated and beneficially affects the course of the disease. Conclusion: Although numbers in Western European countries are decreasing rapidly, reliable diagnostic screening for hepatitis A-E is necessary to identify the etiology and to determine those most at risk of developing ALF.

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Liver Fibrosis Markers Improve Prediction of Outcome in Non‐Acetaminophen‐Associated Acute Liver Failure

Ugamura

Chu

Nakamoto

et al. 2018

Hepatology Communications

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A prognostic system for acute liver failure (ALF) with a higher predictive value is urgently needed. The role of extracellular matrix (ECM) remodeling in ALF has not been fully elucidated. We hypothesized that serologic fibrosis markers, which reflect ECM remodeling, are predictive of ALF outcome at first presentation. This observational study included 110 patients with acute liver dysfunction, of which 73 had non‐acetaminophen‐associated ALF (NAA‐ALF). We evaluated serum levels of hyaluronic acid, 7S domain of type IV collagen (4COL7S), and Wisteria floribunda agglutinin‐positive Mac‐2‐binding protein at first presentation to a tertiary center. Serologic fibrosis markers were significantly higher in NAA‐ALF compared with acute hepatitis. Elevated hyaluronic acid and 4COL7S levels at first presentation correlated significantly with worse clinical outcomes. 4COL7S, along with age, ammonia, and the Model for End‐Stage Liver Disease (MELD) score, was a significant prognostic factor in multivariate analysis; 4COL7S correlated significantly with coagulopathy, decreased hepatic synthetic functions, advanced hepatic encephalopathy, and liver atrophy and also predicted 180‐day transplant‐free survival. Cox regression models incorporating 4COL7S with the MELD system had profoundly improved predictive values that significantly surpassed the MELD system alone. Conclusion: Elevation of serologic fibrosis markers reflecting ECM remodeling in NAA‐ALF predicted a worse clinical outcome. Incorporation of 4COL7S at first presentation to a transplant center improves the specificity while retaining the sensitivity of the MELD system. External validation of a fibrosis marker as part of a clinical prediction tool in ALF warrants further investigation.

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Acute Liver Failure

Abstract: Precise epidemiological data on ALF are still lacking in Germany, as are prospective, randomized trials of treatments for it. It is nonetheless clear that progress has been made in its diagnosis and treatment.

Cited by 47 publications

References 42 publications

Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Liver Failure due to Acute Viral Hepatitis (A-E)

Liver Fibrosis Markers Improve Prediction of Outcome in Non‐Acetaminophen‐Associated Acute Liver Failure

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