Acute liver failure

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 20 Nov 2025

Last updated: 31 Dec 2024

Acute liver failure is a rare, life-threatening, potentially reversible condition defined by jaundice, coagulopathy, and hepatic encephalopathy.

Occurs in patients with no preexisting liver disease and may result in severe liver impairment and rapid clinical deterioration.

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

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

Treatment involves intensive care unit monitoring, specific therapies based on etiology, 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.

Определение

Acute liver failure (ALF) is a rare, life-threatening, potentially reversible condition with a rapid decline in hepatic function characterized by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease.[1][2][3][4]

If these symptoms occur in a patient with preexisting liver disease, the term acute-on-chronic liver failure is used, and is considered a separate diagnosis from ALF.[4][5]

ALF may be classified as hyperacute, acute, or subacute, depending on the interval from the onset of jaundice to the development of encephalopathy.[3][4][6]

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][2][7]

Анамнез и осмотр

Ключевые диагностические факторы

hepatotoxic drugs
chronic alcohol misuse
pregnancy
jaundice
coagulopathy
signs of hepatic encephalopathy

Полная информация

Другие диагностические факторы

absence of history of chronic liver disease
abdominal pain
nausea
vomiting
malaise
signs of cerebral edema
right upper quadrant tenderness
hepatomegaly
absence of splenomegaly
absence of spider angiomata
absence of palmar erythema
absence of ascites
depression or suicidal ideation
Wilson disease
exposure to hepatotoxins
illicit drug use
absence of malignancy

Полная информация

Факторы риска

chronic alcohol misuse
poor nutritional status or fasting
female sex
age >40 years
pregnancy
chronic hepatitis B
chronic pain and narcotic use
herbal and dietary supplement hepatotoxicity
Wilson disease
acetaminophen and antidepressant therapy
chronic hepatitis C
HIV and hepatitis C coinfection

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

liver function tests
prothrombin time/INR
viscoelastic testing (VET)
basic metabolic panel
CBC
blood type and screen
serum amylase and lipase
arterial blood gas
arterial blood lactate
acetaminophen level
urine toxicology screen
viral hepatitis serologies
autoimmune hepatitis markers
pregnancy test
chest x-ray
abdominal ultrasound with Doppler

Полная информация

Исследования, проведение которых нужно рассмотреть

factor V level
viral hepatitis polymerase chain reaction (PCR) studies
serum ceruloplasmin
serum copper
24-hour urinary copper excretion
slit-lamp ophthalmologic examination
arterial ammonia
HIV test
urinalysis and urine sodium
surveillance cultures
Coombs test
biomarkers
liver biopsy
CT scan of head
CT/MR cholangiography
transcranial Doppler

Полная информация

Алгоритм лечения

Острый

all patients

Составители

Авторы

Stevan A. Gonzalez, MD, MS

Associate Professor

Department of Internal Medicine

TCU and UNTHSC School of Medicine

Medical Director of Liver Transplantation

Annette C. and Harold C. Simmons Transplant Institute

Baylor All Saints Medical Center

Fort Worth

Раскрытие информации

SG is a paid consultant and speaker for Mallinckrodt Pharmaceuticals.

Выражение благодарностей

Dr Stevan Gonzalez would like to gratefully acknowledge the late Dr Emmet B. Keeffe who previously co-contributed to this topic; an esteemed colleague, friend, and mentor.

Раскрытие информации

EBK declared that he had no competing interests.

Рецензенты

Timothy J. Davern, MD

Director of Acute Liver Failure Program

California Pacific Medical Center Liver Transplant Program

San Francisco

Раскрытие информации

Not disclosed.

Muhammad Dawwas, MRCP

Specialist Registrar

Liver Unit

Addenbrooke's Hospital

Cambridge

Раскрытие информации

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Shingina A, Mukhtar N, Wakim-Fleming J, et al. Acute liver failure guidelines. Am J Gastroenterol. 2023 Jul 1;118(7):1128-53.Полный текст Аннотация

Lee WM, Squires RH Jr, Nyberg SL, et al. Acute liver failure: summary of a workshop. Hepatology. 2008 Apr;47(4):1401-15.Полный текст Аннотация

American Association for the Study of Liver Diseases. AASLD position paper: the management of acute liver failure: update 2011. Nov 2011 [internet publication].Полный текст

Wendon J, Cordoba J, Dhawan A, et al; European Association for the Study of the Liver. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66(5):1047-81.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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- Severe acute hepatitis
- Cholestasis
- Hemolysis
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Acute liver failure

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

all patients

Составители

Авторы

Stevan A. Gonzalez, MD, MS

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Timothy J. Davern, MD

Раскрытие информации

Muhammad Dawwas, MRCP

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Videos

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice