Acute Liver Failure - DDW 2005

[Guest guest]

Medscape coverage of: Digestive Disease Week 2005 | Highlights in Liver

Disease

Issues in Cirrhosis and Liver Transplantation

Tram T. Tran, MD

Acute Liver Failure

Acute liver failure is manifest by jaundice, coagulopathy, and

encephalopathy within 26 weeks, and carries a high mortality (> 80%) without

transplant. The US Acute Failure Study Group led by Lorenzo Rossaro

published their study results investigating the prognostic value of the MELD

score in 729 adult patients with acute liver failure.[15] Although they

found that a MELD score of < 30 (negative predictive value 82%) may predict

spontaneous survival, a high MELD score did not predict poor outcome well.

and colleagues[16] analyzed 29 patients with acute liver failure

secondary to acute hepatitis A, and reported a 45% death or transplant rate.

Factors associated with poor outcome were sex (male), low alanine amino

transferase (ALT) and alkaline phosphatase levels, and higher serum

creatinine. The study authors then developed a 4-variable index for

predicting poor prognosis using any 2 out of 4 criteria upon admission to

yield a positive predictive value of 86% and negative predictive value of

93%: creatinine > 2.0 mg/dL, ALT < 2600 IU/mL, use of pressors, or

intubation. This group also reported the outcome in patients who had acute

liver failure secondary to hepatic ischemia and as would be expected,

cardiopulmonary disease and hypotension were identified risk factors.[17]

Mortality rate in this group was 34%, and renal function again played a role

in prognosis. Early prediction of which patients will require

transplantation is still a difficult and elusive clinical task, and will

require further study.

[Guest guest]

Medscape coverage of: Digestive Disease Week 2005 | Highlights in Liver

Disease

Issues in Cirrhosis and Liver Transplantation

Tram T. Tran, MD

Acute Liver Failure

Acute liver failure is manifest by jaundice, coagulopathy, and

encephalopathy within 26 weeks, and carries a high mortality (> 80%) without

transplant. The US Acute Failure Study Group led by Lorenzo Rossaro

published their study results investigating the prognostic value of the MELD

score in 729 adult patients with acute liver failure.[15] Although they

found that a MELD score of < 30 (negative predictive value 82%) may predict

spontaneous survival, a high MELD score did not predict poor outcome well.

and colleagues[16] analyzed 29 patients with acute liver failure

secondary to acute hepatitis A, and reported a 45% death or transplant rate.

Factors associated with poor outcome were sex (male), low alanine amino

transferase (ALT) and alkaline phosphatase levels, and higher serum

creatinine. The study authors then developed a 4-variable index for

predicting poor prognosis using any 2 out of 4 criteria upon admission to

yield a positive predictive value of 86% and negative predictive value of

93%: creatinine > 2.0 mg/dL, ALT < 2600 IU/mL, use of pressors, or

intubation. This group also reported the outcome in patients who had acute

liver failure secondary to hepatic ischemia and as would be expected,

cardiopulmonary disease and hypotension were identified risk factors.[17]

Mortality rate in this group was 34%, and renal function again played a role

in prognosis. Early prediction of which patients will require

transplantation is still a difficult and elusive clinical task, and will

require further study.