Lessons from look-back in acute liver failure? A single centre experience of 3300 patients

William Bernal; Anna Hyyrylainen; Amit Gera; Vinod K. Audimoolam; Mark J. W. McPhail; Georg Auzinger; Mohammed Rela; Nigel Heaton; John G. O'Grady; Julia Wendon; Roger Williams

doi:10.1016/j.jhep.2013.02.010

Lessons from look-back in acute liver failure? A single centre experience of 3300 patients

William Bernal^*, Anna Hyyrylainen, Amit Gera, Vinod K. Audimoolam, Mark J. W. McPhail, Georg Auzinger, Mohammed Rela, Nigel Heaton, John G. O'Grady, Julia Wendon, Roger Williams

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

336 Citations (Scopus)

Abstract

Background & Aims: Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome.

Methods: Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy CALF) and those without (acute liver injury; ALI).

Results: 3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p

Conclusions: The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.

Original language	English
Pages (from-to)	74-80
Number of pages	7
Journal	Journal of Hepatology
Volume	59
Issue number	1
DOIs	https://doi.org/10.1016/j.jhep.2013.02.010
Publication status	Published - Jul 2013

Keywords

Acute liver failure
Critical care
Transplantation
Outcomes
FULMINANT HEPATIC-FAILURE
ARTERIAL AMMONIA
UNITED-KINGDOM
INTENSIVE-CARE
TRANSPLANTATION
ENCEPHALOPATHY
INFECTION
PARACETAMOL
MANAGEMENT
PROGNOSIS

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10.1016/j.jhep.2013.02.010

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@article{d34bd846a7aa4a95a4ed766c58ad03a0,

title = "Lessons from look-back in acute liver failure? A single centre experience of 3300 patients",

abstract = "Background & Aims: Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome. Methods: Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy CALF) and those without (acute liver injury; ALI). Results: 3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p Conclusions: The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.",

keywords = "Acute liver failure, Critical care, Transplantation, Outcomes, FULMINANT HEPATIC-FAILURE, ARTERIAL AMMONIA, UNITED-KINGDOM, INTENSIVE-CARE, TRANSPLANTATION, ENCEPHALOPATHY, INFECTION, PARACETAMOL, MANAGEMENT, PROGNOSIS",

author = "William Bernal and Anna Hyyrylainen and Amit Gera and Audimoolam, {Vinod K.} and McPhail, {Mark J. W.} and Georg Auzinger and Mohammed Rela and Nigel Heaton and O'Grady, {John G.} and Julia Wendon and Roger Williams",

year = "2013",

month = jul,

doi = "10.1016/j.jhep.2013.02.010",

language = "English",

volume = "59",

pages = "74--80",

journal = "Journal of Hepatology",

issn = "0168-8278",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Lessons from look-back in acute liver failure? A single centre experience of 3300 patients

AU - Bernal, William

AU - Hyyrylainen, Anna

AU - Gera, Amit

AU - Audimoolam, Vinod K.

AU - McPhail, Mark J. W.

AU - Auzinger, Georg

AU - Rela, Mohammed

AU - Heaton, Nigel

AU - O'Grady, John G.

AU - Wendon, Julia

AU - Williams, Roger

PY - 2013/7

Y1 - 2013/7

N2 - Background & Aims: Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome. Methods: Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy CALF) and those without (acute liver injury; ALI). Results: 3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p Conclusions: The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.

AB - Background & Aims: Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome. Methods: Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy CALF) and those without (acute liver injury; ALI). Results: 3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p Conclusions: The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.

KW - Acute liver failure

KW - Critical care

KW - Transplantation

KW - Outcomes

KW - FULMINANT HEPATIC-FAILURE

KW - ARTERIAL AMMONIA

KW - UNITED-KINGDOM

KW - INTENSIVE-CARE

KW - TRANSPLANTATION

KW - ENCEPHALOPATHY

KW - INFECTION

KW - PARACETAMOL

KW - MANAGEMENT

KW - PROGNOSIS

U2 - 10.1016/j.jhep.2013.02.010

DO - 10.1016/j.jhep.2013.02.010

M3 - Article

SN - 0168-8278

VL - 59

SP - 74

EP - 80

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 1

ER -

Lessons from look-back in acute liver failure? A single centre experience of 3300 patients

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