Original Article
Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in PortugalSimões C.a · Santos S.b · Vicente M.c · Sousa Cardoso F.daDivision of Gastroenterology, Santa Maria Hospital, Lisbon, Portugal
bDivision of Gastroenterology, Central Lisbon Hospital Center, Lisbon, Portugal cDivision of Internal Medicine, Central Lisbon Hospital Center, Lisbon, Portugal dIntensive Care Unit, Curry Cabral Hospital, Central Lisbon Hospital Center, Lisbon, Portugal Dr. Filipe Sousa Cardoso Intensive Care Unit, Curry Cabral Hospital, Central Lisbon Hospital Center Rua Beneficiência N8 PT–1050-099 Lisbon (Portugal) E-Mail filipe_sousacardoso@hotmail.com Keywords: Liver failureEtiologyTransplantation |
|
Do you have an account?
Abstract
Background and Aims: Acute liver failure (ALF) is a rare disease with potentially high mortality rates. We aimed to study the recent epidemiology of ALF in one of the Portuguese liver transplant (LT) regions. Methods: We assessed a retrospective cohort including 34 consecutive patients with ALF admitted to the intensive care unit (ICU) of Curry Cabral Hospital (Lisbon, Portugal) between October 2013 and December 2016. Results: The median age (IQR) was 49 (31–67) years, and 21 (62%) of the cohort were female. Non-paracetamol etiologies were found in 29 patients (85%). On ICU admission, grade 3–4 hepatic encephalopathy developed in 10 patients (29%); invasive mechanical ventilation, vasopressors, and renal replacement therapy were required for 8 (24%), 7 (21%), and 5 (15%) of the patients, respectively; the King’s College criteria (KCC) were fulfilled by 16 patients (47%). Of the 15 (44%) nontransplanted patients, 11 (73%) died during their hospital stay. Of the 19 (56%) transplanted patients, 4 (21%) died during their hospital stay. KCC were not associated with hospital mortality (p = 0.97), but they were significantly associated with LT (p = 0.008). Conclusions: In a Portuguese cohort of patients with ALF, non-paracetamol etiologies were predominant. Hospital mortality was much lower amongst transplanted patients.
© 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel
Epidemiologia da Falência Hepática Aguda de um Centro de Transplante Regional em Portugal
Palavras Chave
Falência hepática · Etiologia · Transplantação ·
Resumo
Introdução: A falência hepática aguda (ALF) é uma doença rara com potenciais altas taxas de mortalidade. Pretendeu-se estudar a epidemiologia recente da ALF numa das regiões portuguesas de transplante hepático (LT). Materiais e Métodos: Coorte retrospectivo incluindo 34 doentes com ALF consecutivamente admitidos na Unidade de Cuidados Intensivos (ICU) do Hospital Curry Cabral (Lisboa, Portugal) entre Outubro de 2013 e Dezembro de 2016. Resultados: A idade mediana foi 49 (31–67) anos e 21 (62%) doentes eram do sexo feminino. As etiologias não-paracetamol ocorreram em 29 (85%) doentes. Na admissão na ICU, a encefalopatia hepática grau 3–4 desenvolveu-se em 10 (29%) doentes; a ventilação mecânica invasiva, os vasopressores e a técnica de substituição da função renal foram usados em 8 (24%), 7 (21%) e 5 (15%) doentes, respectivamente; os critérios King’s College Hospital (KCC) foram cumpridos por 16 (47%) doentes. Entre os 15 (44%) doentes não transplantados, 11 (73%) morreram durante a estadia hospitalar. Entre os 19 (56%) doentes transplantados, 4 (21%) morreram durante a estadia hospitalar. Os KCC não se associaram com a mortalidade hospitalar (p = 0.97), mas associaram-se significativamente com o LT (p = 0.008). Conclusões: Num coorte de doentes com ALF português, as etiologias não-paracetamol predominaram. A mortalidade hospitalar foi significativamente menor nos doentes transplantados.
Related Articles:
References
- Cardoso FS, Marcelino P, Bagulho L, Karvellas CJ: Acute liver failure: an up-to-date approach. J Crit Care 2017; 39: 25–30.
- Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, et al: Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol 2012; 57: 288–296.
- Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al: Lessons from look-back in acute liver failure? A single centre experience of 3,300 patients. J Hepatol 2013; 59: 74–80.
- Acharya SK, Batra Y, Hazari S, Choudhury V, Panda SK, Dattagupta S: Etiopathogenesis of acute hepatic failure: Eastern versus Western countries. J Gastroenterol Hepatol 2002; 17 (suppl 3):S268–S273.
- Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, et al: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947–954.
- Gulmez SE, Larrey D, Pageaux GP, Bernuau J, Bissoli F, Horsmans Y, et al: Liver transplant associated with paracetamol overdose: results from the seven-country SALT study. Br J Clin Pharmacol 2015; 80: 599–606.
- Hadem J, Tacke F, Bruns T, Langgartner J, Strnad P, Denk GU, et al: Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 2012; 10: 664–669.e2.
- Areia M, Romãozinho JM, Ferreira M, Amaro P, Leitão MC: Fulminant hepatic failure: a Portuguese experience. Eur J Gastroenterol Hepatol 2007; 19: 665–669.
- Fontana RJ, Ellerbe C, Durkalski VE, Rangnekar A, Reddy RK, Stravitz T, et al: Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study. Liver Int 2015; 35: 370–380.
- World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191–2194.
- Bernal W, Hall C, Karvellas CJ, Auzinger G, Sizer E, Wendon J: Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology 2007; 46: 1844–1852.
- O’Grady J: Timing and benefit of liver transplantation in acute liver failure. J Hepatol 2014; 60: 663–670.
- Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, et al: Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ 2013; 346:f403.
- Escorsell A, Mas A, de la Mata M; Spanish Group for the Study of Acute Liver Failure: Acute liver failure in Spain: analysis of 267 cases. Liver Transpl 2007; 13: 1389–1395.
- McPhail MJ, Farne H, Senvar N, Wendon JA, Bernal W: Ability of King’s College criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure: a meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 516–525.e5; quiz e43–e45.
- Craig DGN, Ford AC, Hayes PC, Simpson KJ: Systematic review: prognostic tests of paracetamol-induced acute liver failure. Aliment Pharmacol Ther 2010; 31: 1064–1076.
Article / Publication Details
Received: December 19, 2017
Accepted: January 30, 2018
Published online: March 13, 2018
Issue release date: January - February
Number of Print Pages: 7
Number of Figures: 3
Number of Tables: 3
ISSN: 2341-4545 (Print)
eISSN: 2387-1954 (Online)
For additional information: https://www.karger.com/PJG
References
- Cardoso FS, Marcelino P, Bagulho L, Karvellas CJ: Acute liver failure: an up-to-date approach. J Crit Care 2017; 39: 25–30.
- Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, et al: Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol 2012; 57: 288–296.
- Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al: Lessons from look-back in acute liver failure? A single centre experience of 3,300 patients. J Hepatol 2013; 59: 74–80.
- Acharya SK, Batra Y, Hazari S, Choudhury V, Panda SK, Dattagupta S: Etiopathogenesis of acute hepatic failure: Eastern versus Western countries. J Gastroenterol Hepatol 2002; 17 (suppl 3):S268–S273.
- Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, et al: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947–954.
- Gulmez SE, Larrey D, Pageaux GP, Bernuau J, Bissoli F, Horsmans Y, et al: Liver transplant associated with paracetamol overdose: results from the seven-country SALT study. Br J Clin Pharmacol 2015; 80: 599–606.
- Hadem J, Tacke F, Bruns T, Langgartner J, Strnad P, Denk GU, et al: Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 2012; 10: 664–669.e2.
- Areia M, Romãozinho JM, Ferreira M, Amaro P, Leitão MC: Fulminant hepatic failure: a Portuguese experience. Eur J Gastroenterol Hepatol 2007; 19: 665–669.
- Fontana RJ, Ellerbe C, Durkalski VE, Rangnekar A, Reddy RK, Stravitz T, et al: Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study. Liver Int 2015; 35: 370–380.
- World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191–2194.
- Bernal W, Hall C, Karvellas CJ, Auzinger G, Sizer E, Wendon J: Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology 2007; 46: 1844–1852.
- O’Grady J: Timing and benefit of liver transplantation in acute liver failure. J Hepatol 2014; 60: 663–670.
- Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W, et al: Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ 2013; 346:f403.
- Escorsell A, Mas A, de la Mata M; Spanish Group for the Study of Acute Liver Failure: Acute liver failure in Spain: analysis of 267 cases. Liver Transpl 2007; 13: 1389–1395.
- McPhail MJ, Farne H, Senvar N, Wendon JA, Bernal W: Ability of King’s College criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure: a meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 516–525.e5; quiz e43–e45.
- Craig DGN, Ford AC, Hayes PC, Simpson KJ: Systematic review: prognostic tests of paracetamol-induced acute liver failure. Aliment Pharmacol Ther 2010; 31: 1064–1076.
Open Access License / Drug Dosage / Disclaimer
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Get Permission
PubMed ID
C.S., S.S., and M.V. share first authorship.