TY - JOUR
T1 - Acute liver failure
AU - Stravitz, R. Todd
AU - Lee, William M.
N1 - Funding Information:
Many of the insights gained from writing this Seminar derived from the experience the authors have had with the site investigators, coordinators, and patients and their families who participated in the Acute Liver Failure Study Group (ALFSG) Registry over the past 22 years. We thank David Kleiner (National Cancer Institute, Bethesda, MD, USA) for providing the photomicrographs (figure 2), Michelle Gottfried (Medical University of South Carolina Data Coordinating Unit, Charleston, SC, USA) for managing tables and figures, and the entire ALFSG administrative team. The ALFSG has been supported since 1997 by the National Institute of Diabetes, Digestive and Kidney Diseases, the United States Food and Drug Administration, and the Southwestern Medical Foundation, Dallas, TX, USA.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/9/7
Y1 - 2019/9/7
N2 - Acute liver failure is a rare and severe consequence of abrupt hepatocyte injury, and can evolve over days or weeks to a lethal outcome. A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of aminotransferases, altered mentation, and disturbed coagulation. The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure. Causes of acute liver failure include paracetamol toxicity, hepatic ischaemia, viral and autoimmune hepatitis, and drug-induced liver injury from prescription drugs, and herbal and dietary supplements. Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomised trials, and most treatment recommendations represent expert opinion. Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.
AB - Acute liver failure is a rare and severe consequence of abrupt hepatocyte injury, and can evolve over days or weeks to a lethal outcome. A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of aminotransferases, altered mentation, and disturbed coagulation. The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure. Causes of acute liver failure include paracetamol toxicity, hepatic ischaemia, viral and autoimmune hepatitis, and drug-induced liver injury from prescription drugs, and herbal and dietary supplements. Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomised trials, and most treatment recommendations represent expert opinion. Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.
UR - http://www.scopus.com/inward/record.url?scp=85071717507&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071717507&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(19)31894-X
DO - 10.1016/S0140-6736(19)31894-X
M3 - Review article
C2 - 31498101
AN - SCOPUS:85071717507
SN - 0140-6736
VL - 394
SP - 869
EP - 881
JO - The Lancet
JF - The Lancet
IS - 10201
ER -