TY - JOUR
T1 - Clinical and Neurologic Outcomes in Acetaminophen-Induced Acute Liver Failure
T2 - A 21-Year Multicenter Cohort Study
AU - US Acute Liver Failure Study Group
AU - MacDonald, Andrew J.
AU - Speiser, Jaime L.
AU - Ganger, Daniel R.
AU - Nilles, Kathleen M.
AU - Orandi, Babak J.
AU - Larson, Anne M.
AU - Lee, William M.
AU - Karvellas, Constantine J.
AU - Liou, Iris
AU - Fix, Oren
AU - Schilsky, Michael
AU - McCashland, Timothy
AU - Eileen Hay, J.
AU - Murray, Natalie
AU - Shaikh, A. Obaid S.
AU - Blei, Andres
AU - Ganger, Daniel
AU - Zaman, Atif
AU - Han, Steven H.B.
AU - Robert Fontana, Fontana
AU - McGuire, Brendan
AU - Chung, Raymond T.
AU - Smith, Alastair
AU - Brown, Robert
AU - Crippin, Jeffrey
AU - Harrison, Edwin
AU - Reuben, Adrian
AU - Munoz, Santiago
AU - Reddy, Rajender
AU - Todd Stravitz, R.
AU - Rossaro, Lorenzo
AU - Satyanarayana, Raj
AU - Hassanein, Tarek
AU - Olson, Jodi
AU - Subramanian, Ram
AU - Hanje, James
AU - Hameed, Bilal
N1 - Publisher Copyright:
© 2021 AGA Institute
PY - 2021/12
Y1 - 2021/12
N2 - Background & Aims: Acetaminophen (APAP)-induced acute liver failure (ALF) is a rare disease associated with high mortality rates. This study aimed to evaluate changes in interventions, psychosocial profile, and clinical outcomes over a 21-year period using data from the ALF Study Group registry. Methods: A retrospective review of this prospective, multicenter cohort study of all APAP–ALF patients enrolled during the study period (1998–2018) was completed. Primary outcomes evaluated were the 21-day transplant-free survival (TFS) and neurologic complications. Covariates evaluated included enrollment cohort (early, 1998–2007; recent, 2008–2018), intentionality, psychiatric comorbidity, and use of organ support including continuous renal replacement therapy (CRRT). Results: Of 1190 APAP–ALF patients, recent cohort patients (n = 608) had significantly improved TFS (recent, 69.8% vs early, 61.7%; P = .005). Recent cohort patients were more likely to receive CRRT (22.2% vs 7.6%; P < .001), and less likely to develop intracranial hypertension (29.9% vs 51.5%; P < .001) or die by day 21 from cerebral edema (4.5% vs 11.6%; P < .001). Grouped by TFS status (non-TFS, n = 365 vs TFS, n = 704), there were no differences in psychiatric comorbidity (51.5% vs 55.0%; P = .28) or intentionality (intentional, 39.7% vs 41.6%; P = .58). On multivariable logistic regression adjusting for vasopressor support, development of grade 3/4 hepatic encephalopathy, King's College criteria, and MELD score, the use of CRRT (odds ratio, 1.62; P = .023) was associated with significantly increased TFS (c-statistic, 0.86). In a second model adjusting for the same covariates, recent enrollment was associated significantly with TFS (odds ratio, 1.42; P = .034; c-statistic, 0.86). Conclusions: TFS in APAP–ALF has improved in recent years and rates of intracranial hypertension/cerebral edema have decreased, possibly related to increased CRRT use.
AB - Background & Aims: Acetaminophen (APAP)-induced acute liver failure (ALF) is a rare disease associated with high mortality rates. This study aimed to evaluate changes in interventions, psychosocial profile, and clinical outcomes over a 21-year period using data from the ALF Study Group registry. Methods: A retrospective review of this prospective, multicenter cohort study of all APAP–ALF patients enrolled during the study period (1998–2018) was completed. Primary outcomes evaluated were the 21-day transplant-free survival (TFS) and neurologic complications. Covariates evaluated included enrollment cohort (early, 1998–2007; recent, 2008–2018), intentionality, psychiatric comorbidity, and use of organ support including continuous renal replacement therapy (CRRT). Results: Of 1190 APAP–ALF patients, recent cohort patients (n = 608) had significantly improved TFS (recent, 69.8% vs early, 61.7%; P = .005). Recent cohort patients were more likely to receive CRRT (22.2% vs 7.6%; P < .001), and less likely to develop intracranial hypertension (29.9% vs 51.5%; P < .001) or die by day 21 from cerebral edema (4.5% vs 11.6%; P < .001). Grouped by TFS status (non-TFS, n = 365 vs TFS, n = 704), there were no differences in psychiatric comorbidity (51.5% vs 55.0%; P = .28) or intentionality (intentional, 39.7% vs 41.6%; P = .58). On multivariable logistic regression adjusting for vasopressor support, development of grade 3/4 hepatic encephalopathy, King's College criteria, and MELD score, the use of CRRT (odds ratio, 1.62; P = .023) was associated with significantly increased TFS (c-statistic, 0.86). In a second model adjusting for the same covariates, recent enrollment was associated significantly with TFS (odds ratio, 1.42; P = .034; c-statistic, 0.86). Conclusions: TFS in APAP–ALF has improved in recent years and rates of intracranial hypertension/cerebral edema have decreased, possibly related to increased CRRT use.
KW - Cerebral Edema
KW - Continuous Renal Replacement Therapy Intracranial Hypertension
KW - Transplant-Free Survival
KW - Transplantation
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U2 - 10.1016/j.cgh.2020.09.016
DO - 10.1016/j.cgh.2020.09.016
M3 - Article
C2 - 32920216
AN - SCOPUS:85097222153
SN - 1542-3565
VL - 19
SP - 2615-2625.e3
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 12
ER -