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{{Acute liver failure}}
{{Acute liver failure}}
{{CMG}} {{AE}} {{HS}} {{ADI}}
{{CMG}} {{AE}} {{HS}} {{ADI}}
==Overview==
==Overview==
 
Acute liver failure may be classified on the basis of the time interval between the onset of symptoms and the development of [[encephalopathy]] as hyperacute, [[acute]], [[subacute]], [[fulminant]], subfulminant and late-onset. The different classification systems used are O’Grady system, Bernuau system, and Japanese system. This classification based on time duration provides helpful clues about [[etiology]], [[complications]], and [[prognosis]] such as in hyperacute cases, the cause is usually [[viral infections]] or [[acetaminophen toxicity]]. The subacute cases can be due to [[Idiosyncratic drug reaction|idiosyncratic drug reactions]] and can also be confused with [[chronic liver disease]]. The hyperacute liver failure has a better [[prognosis]] than subacute liver failure.
==Classification==
==Classification==
Acute liver failure may be classified on the basis of the duration of the [[symptoms]] between the onset of [[jaundice]] to the onset of [[encephalopathy]]. The different classification systems based on the number of weeks from the appearance of jaundice to the encephalopathy are:<ref>O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. ''[[The Lancet|Lancet]] 1993;342:273-5. PMID 8101303.''</ref> <ref name="ogredy1">{{cite journal |author=O'Grady JG |title=Acute liver failure |journal=Postgraduate medical journal |volume=81 |issue=953 |pages=148-54 |year=2005 |pmid=15749789 |doi=10.1136/pgmj.2004.026005}}</ref><ref name="pmid9027947">{{cite journal |author=Williams R |title=Classification, etiology, and considerations of outcome in acute liver failure |journal=[[Seminars in Liver Disease]] |volume=16 |issue=4 |pages=343–8 |year=1996 |month=November |pmid=9027947 |doi=10.1055/s-2007-1007247 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-1007247 |accessdate=2012-10-26}}</ref><ref name="O'Grady-1993">{{Cite journal | last1 = O'Grady | first1 = JG. | last2 = Schalm | first2 = SW. | last3 = Williams | first3 = R. | title = Acute liver failure: redefining the syndromes. | journal = Lancet | volume = 342 | issue = 8866 | pages = 273-5 | month = Jul | year = 1993 | doi = | PMID = 8101303 }}</ref><ref name="Bernuau-1986">{{Cite journal | last1 = Bernuau | first1 = J. | last2 = Rueff | first2 = B. | last3 = Benhamou | first3 = JP. | title = Fulminant and subfulminant liver failure: definitions and causes. | journal = Semin Liver Dis | volume = 6 | issue = 2 | pages = 97-106 | month = May | year = 1986 | doi = 10.1055/s-2008-1040593 | PMID = 3529410 }}</ref><ref name="Mochida-2008">{{Cite journal | last1 = Mochida | first1 = S. | last2 = Nakayama | first2 = N. | last3 = Matsui | first3 = A. | last4 = Nagoshi | first4 = S. | last5 = Fujiwara | first5 = K. | title = Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis. | journal = Hepatol Res | volume = 38 | issue = 10 | pages = 970-9 | month = Oct | year = 2008 | doi = 10.1111/j.1872-034X.2008.00368.x | PMID = 18462374 }}</ref>
Acute liver failure may be classified on the basis of the duration of the [[symptoms]] between the onset of [[jaundice]] to the onset of [[encephalopathy]]. The different classification systems based on the number of weeks from the appearance of [[jaundice]] to the [[encephalopathy]] are:<ref>O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. ''[[The Lancet|Lancet]] 1993;342:273-5. PMID 8101303.''</ref><ref name="ogredy1">{{cite journal |author=O'Grady JG |title=Acute liver failure |journal=Postgraduate medical journal |volume=81 |issue=953 |pages=148-54 |year=2005 |pmid=15749789 |doi=10.1136/pgmj.2004.026005}}</ref><ref name="pmid9027947">{{cite journal| author=Williams R| title=Classification, etiology, and considerations of outcome in acute liver failure. | journal=Semin Liver Dis | year= 1996 | volume= 16 | issue= 4 | pages= 343-8 | pmid=9027947 | doi=10.1055/s-2007-1007247 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9027947  }} </ref><ref name="pmid8101303">{{cite journal| author=O'Grady JG, Schalm SW, Williams R| title=Acute liver failure: redefining the syndromes. | journal=Lancet | year= 1993 | volume= 342 | issue= 8866 | pages= 273-5 | pmid=8101303 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8101303 }} </ref><ref name="pmid3529410">{{cite journal| author=Bernuau J, Rueff B, Benhamou JP| title=Fulminant and subfulminant liver failure: definitions and causes. | journal=Semin Liver Dis | year= 1986 | volume= 6 | issue= 2 | pages= 97-106 | pmid=3529410 | doi=10.1055/s-2008-1040593 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3529410 }} </ref><ref name="pmid18462374">{{cite journal| author=Mochida S, Nakayama N, Matsui A, Nagoshi S, Fujiwara K| title=Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis. | journal=Hepatol Res | year= 2008 | volume= 38 | issue= 10 | pages= 970-9 | pmid=18462374 | doi=10.1111/j.1872-034X.2008.00368.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462374 }} </ref>
 
{|
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Classification system
! Classification system!! Duration  
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Duration  
|-
|-
| O’Grady System||
| style="background:#DCDCDC;" align="center" + | O’Grady System
| style="background:#F5F5F5;" + |
* Hyperacute  (0 - 1 week)
* Hyperacute  (0 - 1 week)
* Acute            ( From  2nd week - 4 weeks)
* Acute            ( From  2nd week - 4 weeks)
* Subacute      ( From 4th week - 12 weeks)
* Subacute      ( From 4th week - 12 weeks)
|-
|-
| Bernuau System||
| style="background:#DCDCDC;" align="center" + | Bernuau System
| style="background:#F5F5F5;" + |
* Fulminant      ( 0 - 2 weeks)   
* Fulminant      ( 0 - 2 weeks)   
* Subfulminant  ( 2 weeks - 12 weeks)
* Subfulminant  ( 2 weeks - 12 weeks)
|-
|-
|Japanese System ||
| style="background:#DCDCDC;" align="center" + |Japanese System
| style="background:#F5F5F5;" + |
* Fulminant      (0 - 8 weeks)
* Fulminant      (0 - 8 weeks)
** Acute      ( 0 - 1.5 weeks)
** Acute      ( 0 - 1.5 weeks)
** Subacute ( 1.5 weeks - 8 weeks)
** Subacute ( 1.5 weeks - 8 weeks)
* Late-Onset    ( 8 weeks - 12 weeks)  
* Late-Onset    ( 8 weeks - 12 weeks)  
|}
|}


* This classification based on time duration provides helpful clues about etiology, complications, and prognosis such as in hyperacute cases the cause is usually viral infections or acetaminophen toxicity.
* This classification based on time duration provides helpful clues about [[etiology]], [[complications]], and [[prognosis]] such as in hyperacute cases, the cause is usually [[viral infections]] or [[acetaminophen toxicity]].  
* The subacute cases can be due to idiosyncratic drug reactions and can also be confused with chronic liver disease.
* The subacute cases can be due to [[Idiosyncratic drug reaction|idiosyncratic]] drug reactions and can also be confused with [[chronic liver disease]].
* The hyperacute liver failure has a better prognosis than subacute liver failure.
* The hyperacute liver failure has a better [[prognosis]] than subacute liver failure.
===Classification based on etiology===
===Classification based on etiology===
There is no established classification of acute liver failure on the basis of [[Etiology|etiology.]] However, it can be classified on the basis of [[etiology]] as:<ref name="pmid18318440">{{cite journal |vauthors=Lee WM, Squires RH, Nyberg SL, Doo E, Hoofnagle JH |title=Acute liver failure: Summary of a workshop |journal=Hepatology |volume=47 |issue=4 |pages=1401–15 |year=2008 |pmid=18318440 |pmc=3381946 |doi=10.1002/hep.22177 |url=}}</ref><ref name="pmid18452114">{{cite journal |vauthors=Lee WM |title=Etiologies of acute liver failure |journal=Semin. Liver Dis. |volume=28 |issue=2 |pages=142–52 |year=2008 |pmid=18452114 |doi=10.1055/s-2008-1073114 |url=}}</ref>
====Viral====
*The [[viruses]] associated with [[hepatitis]] are hepatitis [[Viral hepatitis|A, B, C, D, E]], [[cytomegalovirus]] (CMV), [[varicella]], [[herpes simplex virus]] (HSV) and [[Adenoviridae|adenovirus]].
====Metabolic====
*[[Hemochromatosis]]
*[[Wilson's disease]]
====Vascular====
*[[Right heart failure|Righ heart failure]]
*[[Portal vein thrombosis]]
*[[Budd-Chiari syndrome|Budd chiari syndrome]]
====Drugs and Toxins====
*[[Acetaminophen|Acetaminopehn]]
*[[Carbon tetrachloride|Carbontetrachloride (CCL4)]]
*[[Isoniazid|Isonizid (INH)]]
*[[Halothane]]
*[[Valproic acid]]
*[[Amanita phalloides]]
====Other====
*[[HELLP syndrome]]
*[[Acute fatty liver of pregnancy]]
*[[Reye's syndrome]]


==References==
==References==

Latest revision as of 16:34, 18 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2] Aditya Govindavarjhulla, M.B.B.S. [3]

Overview

Acute liver failure may be classified on the basis of the time interval between the onset of symptoms and the development of encephalopathy as hyperacute, acute, subacute, fulminant, subfulminant and late-onset. The different classification systems used are O’Grady system, Bernuau system, and Japanese system. This classification based on time duration provides helpful clues about etiology, complications, and prognosis such as in hyperacute cases, the cause is usually viral infections or acetaminophen toxicity. The subacute cases can be due to idiosyncratic drug reactions and can also be confused with chronic liver disease. The hyperacute liver failure has a better prognosis than subacute liver failure.

Classification

Acute liver failure may be classified on the basis of the duration of the symptoms between the onset of jaundice to the onset of encephalopathy. The different classification systems based on the number of weeks from the appearance of jaundice to the encephalopathy are:[1][2][3][4][5][6]

Classification system Duration
O’Grady System
  • Hyperacute (0 - 1 week)
  • Acute ( From 2nd week - 4 weeks)
  • Subacute ( From 4th week - 12 weeks)
Bernuau System
  • Fulminant ( 0 - 2 weeks)
  • Subfulminant ( 2 weeks - 12 weeks)
Japanese System
  • Fulminant (0 - 8 weeks)
    • Acute ( 0 - 1.5 weeks)
    • Subacute ( 1.5 weeks - 8 weeks)
  • Late-Onset ( 8 weeks - 12 weeks)

Classification based on etiology

There is no established classification of acute liver failure on the basis of etiology. However, it can be classified on the basis of etiology as:[7][8]

Viral

Metabolic

Vascular

Drugs and Toxins

Other

References

  1. ↑ O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet 1993;342:273-5. PMID 8101303.
  2. ↑ O'Grady JG (2005). "Acute liver failure". Postgraduate medical journal. 81 (953): 148–54. doi:10.1136/pgmj.2004.026005. PMID 15749789.
  3. ↑ Williams R (1996). "Classification, etiology, and considerations of outcome in acute liver failure". Semin Liver Dis. 16 (4): 343–8. doi:10.1055/s-2007-1007247. PMID 9027947.
  4. ↑ O'Grady JG, Schalm SW, Williams R (1993). "Acute liver failure: redefining the syndromes". Lancet. 342 (8866): 273–5. PMID 8101303.
  5. ↑ Bernuau J, Rueff B, Benhamou JP (1986). "Fulminant and subfulminant liver failure: definitions and causes". Semin Liver Dis. 6 (2): 97–106. doi:10.1055/s-2008-1040593. PMID 3529410.
  6. ↑ Mochida S, Nakayama N, Matsui A, Nagoshi S, Fujiwara K (2008). "Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis". Hepatol Res. 38 (10): 970–9. doi:10.1111/j.1872-034X.2008.00368.x. PMID 18462374.
  7. ↑ Lee WM, Squires RH, Nyberg SL, Doo E, Hoofnagle JH (2008). "Acute liver failure: Summary of a workshop". Hepatology. 47 (4): 1401–15. doi:10.1002/hep.22177. PMC 3381946. PMID 18318440.
  8. ↑ Lee WM (2008). "Etiologies of acute liver failure". Semin. Liver Dis. 28 (2): 142–52. doi:10.1055/s-2008-1073114. PMID 18452114.

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