Acute liver failure

Rare disease associated with jaundice, coagulopathy, and hepatic encephalopathy.

The aetiology and the interval from onset of jaundice to the development of encephalopathy have a significant impact on prognosis.

Aetiology is established by history, serological assays, and exclusion of alternative causes, including acute presentations of chronic liver diseases.

Treatment involves ICU monitoring, specific therapies based on aetiology, and management of known complications.

All patients should be considered for possible liver transplantation.

Prognostic models may be used to assess the probability of spontaneous recovery and are instrumental in selection of patients who should potentially undergo liver transplantation.

Acute liver failure (ALF) is a rare syndrome defined by a rapid decline in hepatic function characterised by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease. [1] Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282-98. http://www.ncbi.nlm.nih.gov/pubmed/4908702?tool=bestpractice.com [2] Gimson AE, O'Grady J, Ede RJ, et al. Late onset hepatic failure: clinical, serological and histological features. Hepatology. 1986 Mar-Apr;6(2):288-94. http://www.ncbi.nlm.nih.gov/pubmed/3082735?tool=bestpractice.com [3] Bernuau J, Rueff B, Benhamou JP. Fulminant and subfulminant liver failure: definitions and causes. Semin Liver Dis. 1986 May;6(2):97-106. http://www.ncbi.nlm.nih.gov/pubmed/3529410?tool=bestpractice.com The interval from the onset of jaundice to the development of encephalopathy occurs within 24 to 26 weeks and may further classify ALF into categories based on hyperacute, acute, or subacute presentations. [4] O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993 Jul 31;342(8866):273-5. http://www.ncbi.nlm.nih.gov/pubmed/8101303?tool=bestpractice.com Although clinical jaundice is considered a defining feature of ALF, it may not always be present, particularly in hyperacute presentations. The term acute liver failure is preferred over fulminant hepatic failure or acute hepatic necrosis, although these terms have been used historically to classify hepatic failure. [1] Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282-98. http://www.ncbi.nlm.nih.gov/pubmed/4908702?tool=bestpractice.com [2] Gimson AE, O'Grady J, Ede RJ, et al. Late onset hepatic failure: clinical, serological and histological features. Hepatology. 1986 Mar-Apr;6(2):288-94. http://www.ncbi.nlm.nih.gov/pubmed/3082735?tool=bestpractice.com [5] Lee WM, Squires RH Jr, Nyberg SL, et al. Acute liver failure: summary of a workshop. Hepatology. 2008;47:1401-1415. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381946/ http://www.ncbi.nlm.nih.gov/pubmed/18318440?tool=bestpractice.com