TY - JOUR
T1 - Outcomes in adults with acute liver failure between 1998 and 2013
T2 - An observational cohort study
AU - Reuben, Adrian
AU - Tillman, Holly
AU - Fontana, Robert J.
AU - Davern, Timothy
AU - Mcguire, Brendan
AU - Stravitz, R. Todd
AU - Durkalski, Valerie
AU - Larson, Anne M.
AU - Liou, Iris
AU - Fix, Oren
AU - Schilsky, Michael
AU - Mccashland, Timothy
AU - Hay, J. Eileen
AU - Murray, Natalie
AU - Shaikh, Obaid S.
AU - Ganger, Daniel
AU - Zaman, Atif
AU - Han, Steven B.
AU - Chung, Raymond T.
AU - Smith, Alastair
AU - Brown, Robert
AU - Crippin, Jeffrey
AU - Harrison, M. Edwyn
AU - Koch, David
AU - Munoz, Santiago
AU - Reddy, K. Rajender
AU - Rossaro, Lorenzo
AU - Satyanarayana, Raj
AU - Hassanein, Tarek
AU - Hanje, A. James
AU - Olson, Jody
AU - Subramanian, Ram
AU - Karvellas, Constantine
AU - Hameed, Bilal
AU - Sherker, Averell H.
AU - Robuck, Patricia
AU - Lee, William M.
N1 - Funding Information:
By the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (DK-U-01-58369).
Publisher Copyright:
© 2016 American College of Physicians.
PY - 2016/6/7
Y1 - 2016/6/7
N2 - Background: Acute liver failure (ALF) is a rare syndrome of severe, rapid-onset hepatic dysfunction-without prior advanced liver disease-that is associated with high morbidity and mortality. Intensive care and liver transplantation provide support and rescue, respectively. Objective: To determine whether changes in causes, disease severity, treatment, or 21-day outcomes have occurred in recent years among adult patients with ALF referred to U.S. tertiary care centers. Design: Prospective observational cohort study. (ClinicalTrials .gov: NCT00518440) Setting: 31 liver disease and transplant centers in the United States. Patients: Consecutively enrolled patients-without prior advanced liver disease-with ALF (n = 2070). Measurements: Clinical features, treatment, and 21-day outcomes were compared over time annually for trends and were also stratified into two 8-year periods (1998 to 2005 and 2006 to 2013). Results: Overall clinical characteristics, disease severity, and distribution of causes remained similar throughout the study period. The 21-day survival rates increased between the two 8-year periods (overall, 67.1% vs. 75.3%; transplant-free survival [TFS], 45.1% vs. 56.2%; posttransplantation survival, 88.3% vs. 96.3% [P < 0.010 for each]). Reductions in red blood cell infusions (44.3% vs. 27.6%), plasma infusions (65.2% vs. 47.1%), mechanical ventilation (65.7% vs. 56.1%), and vasopressors (34.9% vs. 27.8%) were observed, as well as increased use of N-acetylcysteine (48.9% vs. 69.3% overall; 15.8% vs. 49.4% [P < 0.001] in patients with ALF not due to acetaminophen toxicity). When examined longitudinally, overall survival and TFS increased throughout the 16-year period. Limitations: The duration of enrollment, the number of patients enrolled, and possibly the approaches to care varied among participating sites. The results may not be generalizable beyond such specialized centers. Conclusion: Although characteristics and severity of ALF changed little over 16 years, overall survival and TFS improved significantly. The effects of specific changes in intensive care practice on survival warrant further study.
AB - Background: Acute liver failure (ALF) is a rare syndrome of severe, rapid-onset hepatic dysfunction-without prior advanced liver disease-that is associated with high morbidity and mortality. Intensive care and liver transplantation provide support and rescue, respectively. Objective: To determine whether changes in causes, disease severity, treatment, or 21-day outcomes have occurred in recent years among adult patients with ALF referred to U.S. tertiary care centers. Design: Prospective observational cohort study. (ClinicalTrials .gov: NCT00518440) Setting: 31 liver disease and transplant centers in the United States. Patients: Consecutively enrolled patients-without prior advanced liver disease-with ALF (n = 2070). Measurements: Clinical features, treatment, and 21-day outcomes were compared over time annually for trends and were also stratified into two 8-year periods (1998 to 2005 and 2006 to 2013). Results: Overall clinical characteristics, disease severity, and distribution of causes remained similar throughout the study period. The 21-day survival rates increased between the two 8-year periods (overall, 67.1% vs. 75.3%; transplant-free survival [TFS], 45.1% vs. 56.2%; posttransplantation survival, 88.3% vs. 96.3% [P < 0.010 for each]). Reductions in red blood cell infusions (44.3% vs. 27.6%), plasma infusions (65.2% vs. 47.1%), mechanical ventilation (65.7% vs. 56.1%), and vasopressors (34.9% vs. 27.8%) were observed, as well as increased use of N-acetylcysteine (48.9% vs. 69.3% overall; 15.8% vs. 49.4% [P < 0.001] in patients with ALF not due to acetaminophen toxicity). When examined longitudinally, overall survival and TFS increased throughout the 16-year period. Limitations: The duration of enrollment, the number of patients enrolled, and possibly the approaches to care varied among participating sites. The results may not be generalizable beyond such specialized centers. Conclusion: Although characteristics and severity of ALF changed little over 16 years, overall survival and TFS improved significantly. The effects of specific changes in intensive care practice on survival warrant further study.
UR - http://www.scopus.com/inward/record.url?scp=84973461644&partnerID=8YFLogxK
U2 - 10.7326/M15-2211
DO - 10.7326/M15-2211
M3 - Article
C2 - 27043883
AN - SCOPUS:84973461644
SN - 0003-4819
VL - 164
SP - 724
EP - 732
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 11
ER -