Occult HBV infection in acute liver failure patients in the united states

Teo, Eng Kiong; Ostapowicz, George; Hussain, Maryam; Wm, Lee; Lok, Anna S.

doi:10.1016/s0016-5085(00)86171-5

Cited by 3 publications

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“…Viruses have been prime targets of interest in indeterminate cases. However, the ALF Study Group was unable to identify any cases of occult hepatitis B, 37 SEN-V virus, 38 or fulminant hepatitis E in the United States, nor was there evidence of parvovirus B19 in the large series of adult patients. 39 Studies to date exposing ALF patients' sera to gene chips containing a pool of RNA and DNA viruses have also been unrevealing (unpublished data).…”

Section: Specific Etiologiesmentioning

confidence: 96%

“…Nonetheless, they do not appear to have features of occult hepatitis B. 37 Recently, consideration has been given to whether such cases were examples of unrecognized autoimmune hepatitis. A recent study suggested that as many as 50% of seronegative or cryptogenic ALF cases either had evidence of autoantibodies, suggesting again that thorough serological screening had not been routinely performed, or had clinical features that gave high clinical scores for likelihood of an autoimmune diagnosis.…”

Section: Indeterminate Cause Of Alfmentioning

confidence: 99%

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Etiologies of Acute Liver Failure

Lee¹

2008

Semin Liver Dis

217

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Acute liver failure is present when any type of rapid-onset liver insult results in a common systemic pathophysiologic picture: altered mental status, vasodilation, renal and pulmonary failure, frequent infection, and poor outcome without transplantation. Identifying which of the many different causes is a first step in understanding prognosis and options for treatment. However, identifying the correct cause can be difficult and sometimes impossible. Any discussion of etiologies must take a historical perspective; there have been several evolving trends nationally and internationally over the past three decades. Etiologies also vary worldwide with considerable differences apparent between Western countries and the developing world. In Europe and North America a large proportion of cases are due to acetaminophen and to idiosyncratic drug reactions, whereas reports from emerging countries in Asia and Africa feature viral illnesses, particularly hepatitis B and E. Determining etiology is important for two reasons: specific antidotes or therapies may be indicated once the diagnosis is known, and knowing the cause provides a reasonably valid guide to predicting outcome.

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Section: Specific Etiologiesmentioning

confidence: 96%

Section: Indeterminate Cause Of Alfmentioning

confidence: 99%

Etiologies of Acute Liver Failure

Lee¹

2008

Semin Liver Dis

217

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Acute liver failure

Fontana

Quallich

2001

Current Opinion in Gastroenterology

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Molecular Adsorbent Recirculating System (MARS)

Tan

2004

Ann Acad Med Singap

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Introduction: Molecular adsorbent recirculating system (MARS) for albumin liver dialysis has been used as a bridge to liver transplantation in patients with fulminant hepatic failure (FHF). This review examines the available data on its clinical use, its technical aspects and present gaps in knowledge. Methods: Peer-reviewed journals and monographs on the subject were covered. Results: FHF is associated with elevation in various substances including bilirubin, ammonia, lactate, free fatty acids and aromatic amino acids. Some of these toxic metabolites, such as ammonia and bilirubin, are believed to be central to the clinical manifestations of hepatic encephalopathy and acute renal failure. MARS ameliorates both biochemical and clinical manifestations of FHF by removing both water-soluble and protein-bound toxins. Among the benefits of MARS is the attenuation of severe cerebral oedema and raised intracranial pressure found in FHF, possibly through reduction in high concentrations of these toxins. Although MARS has been shown to be useful in FHF, its clinical efficacy in subfulminant hepatic failure and less severe forms of acute liver failure (ALF) remains uncertain. The current literature also suggests that it may be beneficial to treat cases of acute-on-chronic liver failure (AoCLF). Deranged systemic chemistries can be similarly ameliorated, but the impact of MARS on the natural history of AoCLF remains uncertain. The difficulty lies in being able to accurately quantify residual liver function and variability in the course of acute intercurrent events. The broader question is whether MARS can favourably change the natural history of ALF and FHF. For this, large multi-centre, randomised controlled trials are needed. Furthermore, it is also uncertain how hepatic excretory-assist devices, such as MARS, compare with bio-artificial liver-assist devices which have both synthetic and excretory hepatic functions in ALF treatment in intensive care unit patients. Nevertheless, MARS has proven to be a valuable homeostatic tool that may be useful in restoring the biochemical and clinical status quo in much the same way that continuous veno-venous haemofiltration and mechanical ventilation provide temporary artificial organ support while these organs are in distress. This is the evolving concept of multi-organ support therapy. Other major unresolved issues with MARS include the timing of initiation of albumin liver dialysis, the clinical and/or biochemical parameters to base this decision on, the intensity of MARS therapy (continuous versus intermittent) and the saturation capacity of the system for different metabolites in intermittent MARS. Conclusions: MARS is an effective and, thus far, safe homeostatic tool in treating FHF. More studies are needed to delineate its role as a homeostatic tool in less severe forms of ALF, including that which occurs in multi-organ failure and in AoCLF. Other studies need to focus on the optimal timing of initiation of and intensity of MARS albumin liver dialysis. The larger issue is to compare MARS with bio-assist liver devices in treating the whole spectrum of ALF.

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Occult HBV infection in acute liver failure patients in the united states

Cited by 3 publications

References 0 publications

Etiologies of Acute Liver Failure

Etiologies of Acute Liver Failure

Acute liver failure

Molecular Adsorbent Recirculating System (MARS)

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