Abstract:Background
Knowledge about patients with acute liver failure (ALF) in Australia and New Zealand (ANZ) is lacking.
Aims
To evaluate whether the pattern of ALF would be similar to previous studies and whether, despite potentially low transplantation rates, mortality would be comparable.
Methods
We obtained data from the ANZ Intensive Care Society Adult Patient Database and the ANZ Liver Transplant Registry for 10 years commencing 2005 and analysed for patient outcomes.
Results
During the study period, 1 022 698 … Show more
“…Furthermore, LT was rarely carried out despite the extremely high mortality associated with untreated disease. Previously published data about LT in ALF are scarce and often reflect specific cohorts (26); the rate ranges from 0% to 23% (15,(26)(27)(28)(29). The median age of the patients was higher than reported in cohort analyses (17,18), but similar to that of patients from Japan (28) and patients with DILI (30,31), as well as to that in the Taiwanese population-based analysis (5).…”
A cute liver failure (ALF) is defined as a potentially reversible, acute impairment of liver function characterized by jaundice, coagulopathy with international normalized ratio (INR) >1.5, and hepatic enceph alopathy in patients without pre-existing liver disease (1). ALF is considered infrequent, but is associated with high mortality without liver transplantation (LT) (2-4). Therefore, it is important to identify ALF in good time to refer patients to a liver transplant center. Since there are no national registries, the true incidence is unknown. Currently, only estimates based on cohort studies are available, while population-based data are rare (5,6).ALF can be caused by toxic, viral, autoimmune, or, more rarely, hereditary liver diseases. In Europe, North America, and Japan, the most common reasons for ALF are drug-induced liver injury (DILI), acute viral hepatitis, and cryptogenic liver failure (2-4). The impact of viral hepatitis has decreased in the past few decades, due partly to immunization programs (4). However, acute viral hepatitis is still the most common cause of ALF in developing countries (7). Worldwide, occasional cases of ALF are caused by autoimmune hepatitis and Wilson's disease (8,9).The Federal Association of the AOK (Allgemeine Ortskrankenkasse) is the largest German health insurance organization with about 26.5 million insured individuals in 2018 (10). This amounts to almost one third of the German population (11).The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the AOK Federal Association. We also investigated gender distribution, etiologies, drug prescriptions before ALF, death and the subsequent necessity of LT.
Methods
Study designThe German health care system is based on statutory and private health insurance (12). The vast majority of people have statutory health insurance provided by different organizations (13). We evaluated the incidence of ALF in Germany based on the accounting data of the AOK, which is the largest statutory health insurance company. The data were extrapolated to the total population. As a validity check, figures on LTs actually performed in Germany with the main diagnosis ALF were requested from Eurotransplant and compared with the study results.
“…Furthermore, LT was rarely carried out despite the extremely high mortality associated with untreated disease. Previously published data about LT in ALF are scarce and often reflect specific cohorts (26); the rate ranges from 0% to 23% (15,(26)(27)(28)(29). The median age of the patients was higher than reported in cohort analyses (17,18), but similar to that of patients from Japan (28) and patients with DILI (30,31), as well as to that in the Taiwanese population-based analysis (5).…”
A cute liver failure (ALF) is defined as a potentially reversible, acute impairment of liver function characterized by jaundice, coagulopathy with international normalized ratio (INR) >1.5, and hepatic enceph alopathy in patients without pre-existing liver disease (1). ALF is considered infrequent, but is associated with high mortality without liver transplantation (LT) (2-4). Therefore, it is important to identify ALF in good time to refer patients to a liver transplant center. Since there are no national registries, the true incidence is unknown. Currently, only estimates based on cohort studies are available, while population-based data are rare (5,6).ALF can be caused by toxic, viral, autoimmune, or, more rarely, hereditary liver diseases. In Europe, North America, and Japan, the most common reasons for ALF are drug-induced liver injury (DILI), acute viral hepatitis, and cryptogenic liver failure (2-4). The impact of viral hepatitis has decreased in the past few decades, due partly to immunization programs (4). However, acute viral hepatitis is still the most common cause of ALF in developing countries (7). Worldwide, occasional cases of ALF are caused by autoimmune hepatitis and Wilson's disease (8,9).The Federal Association of the AOK (Allgemeine Ortskrankenkasse) is the largest German health insurance organization with about 26.5 million insured individuals in 2018 (10). This amounts to almost one third of the German population (11).The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the AOK Federal Association. We also investigated gender distribution, etiologies, drug prescriptions before ALF, death and the subsequent necessity of LT.
Methods
Study designThe German health care system is based on statutory and private health insurance (12). The vast majority of people have statutory health insurance provided by different organizations (13). We evaluated the incidence of ALF in Germany based on the accounting data of the AOK, which is the largest statutory health insurance company. The data were extrapolated to the total population. As a validity check, figures on LTs actually performed in Germany with the main diagnosis ALF were requested from Eurotransplant and compared with the study results.
“…Data from a specific admission diagnosis cohort within the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation database successfully provided preliminary information of clinical problems in other studies, and this was used to guide further research and changes in clinical practice. 16,31,32,34,35 As the database was designed principally for quality control of intensive care across the Australasian region, the head and neck cancer specific cohort information is heterogeneous, and it is not possible to stratify outcomes based on tumour subsite and grading. The number of head and neck cancer patients admitted to the intensive care unit since 2000 has significantly increasedMortality in the intensive care unit was only 0.7 per cent for head and neck cancer patientsMedian intensive care unit admission time was 1.04 days for head and neck cancer patientsMortality risk for head and neck cancer patients in hospital has decreased three-fold from 2000 to 2015Up to half of head and neck cancer patients admitted to the intensive care unit could have care delivered elsewhere in the hospital…”
Objective
To report intensive care unit admission outcomes for head and neck cancer patients.
Methods
A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units.
Results
There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001).
Conclusion
Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.
“…As previously described, all adult liver transplant ICUs in ANZ hospitals were invited to submit detailed de‐identified retrospective clinical data relating to adult patients admitted to ICU with ALF over a 4‐year period concluding at the end of 2016, using a standardized collection tool. Local requirements governing data sharing were adhered to at each site.…”
Section: Methodsmentioning
confidence: 99%
“…Acute liver failure (ALF) leading to intensive care unit (ICU) admission carries a high mortality and more than half of all cases in Australia and New Zealand (ANZ) are due to paracetamol overdose . Regardless of etiology, loss of liver function results in a characteristic pattern of illness, including abnormal measures of hemostasis that are hallmarks of ALF .…”
Background and Aim: To study the management of coagulation and hematological derangements among severe acute liver failure (ALF) patients in Australia and New Zealand liver transplant intensive care units (ICUs). Methods: Analysis of key baseline characteristics, etiology, coagulation and hematological tests, use of blood products, thrombotic complications, and clinical outcomes during the first ICU week. Results: We studied 62 ALF patients. The first day median peak international normalized ratio was 5.5 (inter-quartile range [IQR] 3.8-8.7), median longest activated partial thromboplastin time was 62 s (IQR 44-87), and median lowest fibrinogen was 1.1 (IQR 0.8-1.6) g/L. Fibrinogen was only measured in 85% of patients, which was less than other tests (P < 0.0001). Median initial lowest platelet count was 83 (IQR 41-122) × 10 9 /L. Overall, 58% of patients received fresh frozen plasma, 40% cryoprecipitate, 35% platelets, and 15% prothrombin complex concentrate. Patients with bleeding complications (19%) had more severe overall hypofibrinogenemia and thrombocytopenia. Thrombotic complications were less common (10% of patients), were not associated with consistent patterns of abnormal hemostasis, and were not immediately preceded by clotting factor administration and half occurred only after liver transplantation surgery. Conclusion: In ALF patients admitted to dedicated Australia and New Zealand ICUs, fibrinogen was measured less frequently than other coagulation parameters but, together with platelets, appeared more relevant to bleeding risk. Blood products and procoagulant factors were administered to most patients at variable levels of hemostatic derangement, and bleeding complications were more common than thrombotic complications. This epidemiologic information and practice variability provide baseline data for the design and powering of interventional studies.
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