Acute liver failure

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 18 Aug 2025

Última atualização: 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.

Definição

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]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Autores

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

Declarações

SG is a paid consultant and speaker for Mallinckrodt Pharmaceuticals.

Agradecimentos

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.

Declarações

EBK declared that he had no competing interests.

Revisores

Timothy J. Davern, MD

Director of Acute Liver Failure Program

California Pacific Medical Center Liver Transplant Program

San Francisco

Declarações

Not disclosed.

Muhammad Dawwas, MRCP

Specialist Registrar

Liver Unit

Addenbrooke's Hospital

Cambridge

Declarações

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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

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

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

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Severe acute hepatitis
- Cholestasis
- Hemolysis
Mais Diagnósticos diferenciais
Diretrizes
- Management of adult acute and acute-on-chronic liver failure in the ICU (part II)
- Management of hepatic encephalopathy
Mais Diretrizes
Folhetos informativos para os pacientes
Acute liver failure
Hepatitis C: what is it?
Mais Folhetos informativos para os pacientes
Videos
Tracheal intubation: animated demonstration
Bag-valve-mask ventilation: animated demonstration
More videos
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Acute liver failure

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Stevan A. Gonzalez, MD, MS

Declarações

Agradecimentos

Declarações

Revisores

Timothy J. Davern, MD

Declarações

Muhammad Dawwas, MRCP

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice