The Natural History of Severe Acute Liver Injury
| Autor: | Steven-Huy B. Han, Iris Liou, Constantine J. Karvellas, K.R. Reddy, William M. Lee, Adrian Reuben, Jaime L. Speiser, Averell H. Sherker, Ram Subramanian, Timothy Davern, Anne M. Larson, Richard T. Stravitz, Natalie Murray, A. J. Hanje, Santiago J. Munoz, R.T. Chung, Lorenzo Rossaro, Raj Satyanarayana, Valerie Durkalski, R. S. Brown, Bilal Hameed, David G. Koch, Atif Zaman, Jody C. Olson, Oren K. Fix, Obaid S. Shaikh, Daniel Ganger, Michael L. Schilsky, Robert J. Fontana, Brendan M. McGuire, J. E. Hay, Timothy M. McCashland |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Gastroenterology Severity of Illness Index Article 03 medical and health sciences 0302 clinical medicine Internal medicine Severity of illness medicine Coagulopathy Adverse Drug Reaction Reporting Systems Humans International Normalized Ratio Registries Hepatic encephalopathy Acute liver injury Hepatology biology business.industry Clinical course Alanine Transaminase Middle Aged medicine.disease Prognosis United States Natural history 030104 developmental biology Alanine transaminase Hepatocyte necrosis Data Interpretation Statistical Hepatic Encephalopathy biology.protein 030211 gastroenterology & hepatology Female Chemical and Drug Induced Liver Injury business |
| Zdroj: | The American journal of gastroenterology. 112(9) |
| ISSN: | 1572-0241 |
| Popis: | Acute liver failure (ALF) is classically defined by coagulopathy and hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe acute hepatocyte necrosis without HE, has not been carefully defined nor studied. Our aim is to describe the clinical course of specifically defined ALI, including the risk and clinical predictors of poor outcomes, namely progression to ALF, the need for liver transplantation (LT) and death.386 subjects prospectively enrolled in the Acute Liver Failure Study Group registry between 1 September 2008 through 25 October 2013, met criteria for ALI: International Normalized Ratio (INR)≥2.0 and alanine aminotransferase (ALT)≥10 × elevated (irrespective of bilirubin level) for acetaminophen (N-acetyl-p-aminophenol, APAP) ALI, or INR≥2.0, ALT≥10x elevated, and bilirubin≥3.0 mg/dl for non-APAP ALI, both groups without any discernible HE. Subjects who progressed to poor outcomes (ALF, death, LT) were compared, by univariate analysis, with those who recovered. A model to predict poor outcome was developed using the random forest (RF) procedure.Progression to a poor outcome occurred in 90/386 (23%), primarily in non-APAP (71/179, 40%) vs. only 14/194 (7.2%) in APAP patients comprising 52% of all cases (13 cases did not have an etiology assigned; 5 of whom had a poor outcome). Of 82 variables entered into the RF procedure: etiology, bilirubin, INR, APAP level and duration of jaundice were the most predictive of progression to ALF, LT, or death.A majority of ALI cases are due to APAP, 93% of whom will improve rapidly and fully recover, while non-APAP patients have a far greater risk of poor outcome and should be targeted for early referral to a liver transplant center. |
| Databáze: | OpenAIRE |
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