Acute liver failure natural history, complications and prognosis
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Acute liver failure is a sudden and severe loss of liver function with evidence of encephalopathy and coagulopathy with elevated prothrombin time (PT) and (INR) in a person without preexisting liver disease. The commonly used time duration for an acute liver disease is < 26 weeks. Acute liver failure can be hyperacute, acute or subacute depending upon how long the patient has signs and symptoms of liver failure. If left untreated, patients with acute liver failure can eventually progress to develop confusion, comatose state, and death. Common complications of acute liver failure are hepatic encephalopathy, cerebral edema, coagulopathy, a systemic inflammatory response syndrome, acute renal failure and acute pulmonary failure. The important factors in determining the prognosis of acute liver failure include patients' age, the severity of encephalopathy and the underlying cause of acute liver failure. The commonly used prognostic indicators to predict mortality in patients with acute liver failure and to identify patients who are likely to benefit from liver transplantation include kings college criteria ( used for liver transplantation ) and model for end-stage liver disease (MELD) score (to predict mortality in patients with chronic and acute liver disease).
Acute liver failure is a sudden and severe loss of liver function with evidence of encephalopathy and coagulopathy with elevated prothrombin time (PT) and (INR) in a person without preexisting liver disease. The commonly used time duration for an acute liver disease is < 26 weeks.
- Acute liver failure can be hyperacute, acute or subacute depending upon how long the patient has signs and symptoms of liver failure.
- The natural history of acute liver failure depends on the etiology but generally, cerebral edema mainly presents in hyperacute or acute liver failure, whereas renal shutdown and portal hypertension are the main concerns in the subacute liver failure.
- If left untreated, patients with acute liver failure may initially having nonspecific symptoms such as anorexia, fatigue, nausea and vomiting, diffuse or right upper quadrant abdominal pain or jaundice and can eventually progress to develop confusion and the comatose state and death. A systemic inflammatory response syndrome may also develop. Acute renal failure occurs in up to 50% of cases. The condition can also worsen to the point of causing hemodynamic and cardiovascular compromise.
- The timely recognition and treatment of some of the causes of acute liver failure can reverse the condition and may improve the patient's prognosis. The timely evaluation can also help in identifying patients who may require liver transplantation.
- In acetaminophen toxicity patients, the time duration between acetaminophen ingestion and treatment with acetylcysteine greatly influence the outcome.
- Cerebral edema
- Renal failure
- Renal failure
- Systemic inflammatory response
- Metabolic derrangements
- Pulmonary complications
- The important factors in determining the prognosis of acute liver failure include patients' age, the severity of encephalopathy and the underlying cause of acute liver failure.
- Several prognostic scoring systems to predict mortality in patients with acute liver failure and to identify patients who are likely to benefit from liver transplantation include:
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