Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\28440304
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Gastroenterol
2017 ; 112
(9
): 1389-1396
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
The Natural History of Severe Acute Liver Injury
#MMPMID28440304
Koch DG
; Speiser JL
; Durkalski V
; Fontana RJ
; Davern T
; McGuire B
; Stravitz RT
; Larson AM
; Liou I
; Fix O
; Schilsky ML
; McCashland T
; Hay JE
; Murray N
; Shaikh OS
; Ganger D
; Zaman A
; Han SB
; Chung RT
; Brown RS
; Munoz S
; Reddy KR
; Rossaro L
; Satyanarayana R
; Hanje AJ
; Olson J
; Subramanian RM
; Karvellas C
; Hameed B
; Sherker AH
; Lee WM
; Reuben A
Am J Gastroenterol
2017[Sep]; 112
(9
): 1389-1396
PMID28440304
show ga
OBJECTIVES: Acute liver failure (ALF) is classically defined by coagulopathy and
hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe
acute hepatocyte necrosis without HE, has not been carefully defined nor studied.
Our aim is to describe the clinical course of specifically defined ALI, including
the risk and clinical predictors of poor outcomes, namely progression to ALF, the
need for liver transplantation (LT) and death. METHODS: 386 subjects
prospectively enrolled in the Acute Liver Failure Study Group registry between 1
September 2008 through 25 October 2013, met criteria for ALI: International
Normalized Ratio (INR)?2.0 and alanine aminotransferase (ALT)?10 × elevated
(irrespective of bilirubin level) for acetaminophen (N-acetyl-p-aminophenol,
APAP) ALI, or INR?2.0, ALT?10x elevated, and bilirubin?3.0?mg/dl for non-APAP
ALI, both groups without any discernible HE. Subjects who progressed to poor
outcomes (ALF, death, LT) were compared, by univariate analysis, with those who
recovered. A model to predict poor outcome was developed using the random forest
(RF) procedure. RESULTS: Progression to a poor outcome occurred in 90/386 (23%),
primarily in non-APAP (71/179, 40%) vs. only 14/194 (7.2%) in APAP patients
comprising 52% of all cases (13 cases did not have an etiology assigned; 5 of
whom had a poor outcome). Of 82 variables entered into the RF procedure:
etiology, bilirubin, INR, APAP level and duration of jaundice were the most
predictive of progression to ALF, LT, or death. CONCLUSIONS: A majority of ALI
cases are due to APAP, 93% of whom will improve rapidly and fully recover, while
non-APAP patients have a far greater risk of poor outcome and should be targeted
for early referral to a liver transplant center.
|*Registries
[MESH]
|Adult
[MESH]
|Adverse Drug Reaction Reporting Systems/*statistics & numerical data
[MESH]
|Alanine Transaminase/blood
[MESH]
|Chemical and Drug Induced Liver Injury/blood/complications/*epidemiology
[MESH]
free
free
free
