@article{9290ca3427f946f7bd11ed77710dce94,
title = "Significant lung injury and its prognostic significance in acute liver failure: A cohort analysis",
abstract = "Background and aims: Respiratory failure complicating acute liver failure (ALF) may preclude liver transplantation (LT). We evaluated the association between significant lung injury (SLI) and important clinical outcomes. Methods: Retrospective cohort study of 947 ALF patients with chest radiograph (CXR) and arterial blood gas (ABG) data enrolled in the US Acute Liver Failure Study Group (US-ALFSG) from January 1998 to December 2016. SLI was defined by moderate hypoxaemia (Berlin classification; PaO2/FiO2 < 200 mm Hg) and abnormalities on CXR. Primary outcomes were 21-day transplant-free survival (TFS) and overall survival. Results: Of 947 ALF patients, 370 (39%) had evidence of SLI. ALF patients with SLI (ALF-SLI) had significantly worse oxygenation than controls on admission (median PF ratio 120 vs 300 mm Hg, P <.0001) and higher lactate (6.1 vs 4.6 mmol/l, P =.0008). ALF-SLI patients had higher rates of tracheal (19% vs 14%) and bloodstream (17% vs 11%, P <.005 for both) infections and were more likely to receive transfusions (red cells 55% vs 43%; FFP 74% vs 66%; P <.009 for both). ALF-SLI patients were less likely to receive LT (18% vs 25%, P =.02) and had significantly decreased 21-day TFS (34% vs 42%) and overall survival (49% vs 64%, P <.007 for both). After adjusting for significant covariates (INR, bilirubin, acetaminophen aetiology), the development of SLI was independently associated with decreased 21-day TFS (OR 0.71, P =.03) in ALF patients (C-index 0.78). The incorporation of SLI improved discriminatory ability of the King's College Criteria (P =.0061) but not the ALFSG prognostic index (P =.34). Conclusion: Significant lung injury is a common complication in ALF patients that adversely affects patient outcomes.",
keywords = "ALFSG index, acute liver failure, acute lung injury, prognosis",
author = "Victor Dong and Ken Sun and Michelle Gottfried and Cardoso, {Filipe S.} and McPhail, {Mark J.} and Stravitz, {R. Todd} and Lee, {William M.} and Karvellas, {Constantine J.}",
note = "Funding Information: The study was sponsored by NIH grant U-01 58369 (from NIDDK). Members and institutions participating in the Acute Liver Failure Study Group 1998-2016 are as follows: WM Lee, MD (Principal Investigator); Anne M. Larson, MD, Iris Liou, MD, University of Washington, Seattle, WA; Oren Fix, MD, Swedish Medical Center, Seattle, WA; Michael Schilsky, MD, Yale University, New Haven, CT; Timothy McCashland, MD, University of Nebraska, Omaha, NE; J. Eileen Hay, MBBS, Mayo Clinic, Rochester, MN; Natalie Murray, MD, Baylor University Medical Center, Dallas, TX; A. Obaid S. Shaikh, MD, University of Pittsburgh, Pittsburgh, PA; Andres Blei, MD, Northwestern University, Chicago, IL (deceased), Daniel Ganger, MD, Northwestern University, Chicago, IL; Atif Zaman, MD, University of Oregon, Portland, OR; Steven HB Han, MD, University of California, Los Angeles, CA; Robert Fontana, MD, University of Michigan, Ann Arbor, MI; Brendan McGuire, MD, University of Alabama, Birmingham, AL; Raymond T. Chung, MD, Massachusetts General Hospital, Boston, MA; Alastair Smith, MB, Ch.B., Duke University Medical Center, Durham, NC; Robert Brown, MD, Cornell/Columbia University, New York, NY; Jeffrey Crippin, MD, Washington University, St Louis, MO; Edwin Harrison, Mayo Clinic, Scottsdale, AZ; Adrian Reuben, MBBS, Medical University of South Carolina, Charleston, SC; Santiago Munoz, MD, Albert Einstein Medical Center, Philadelphia, PA; Rajender Reddy, MD, University of Pennsylvania, Philadelphia, PA; R. Todd Stravitz, MD, Virginia Commonwealth University, Richmond, VA; Lorenzo Rossaro, MD, University of California Davis, Sacramento, CA; Raj Satyanarayana, MD, Mayo Clinic, Jacksonville, FL; and Tarek Hassanein, MD, University of California, San Diego, CA; Constantine J. Karvellas MD, University of Alberta, Edmonton, AB; Jodi Olson MD, University of Kansas, Kansas City, KA; Ram Subramanian MD, Emory, Atlanta, GA; James Hanje MD, Ohio State University, Columbus,OH; Bilal Hameed MD, University of California San Francisco, CA. The University of Texas Southwestern Administrative Group included Grace Samuel, Ezmina Lalani, Carla Pezzia, and Corron Sanders, PhD, Nahid Attar, Linda S. Hynan, PhD, and the Medical University of South Carolina Data Coordination Unit included Valerie Durkalski, PhD, Wenle Zhao, PhD, Jaime Speiser, Catherine Dillon, Holly Battenhouse and Michelle Gottfried. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2020",
month = mar,
day = "1",
doi = "10.1111/liv.14268",
language = "English (US)",
volume = "40",
pages = "654--663",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell",
number = "3",
}