Acute Liver Failure in the United States

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The summary below is from the full report titled "Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States." It is in the 17 December 2002 issue of Annals of Internal Medicine (volume 137, pages 947-954). The authors are G Ostapowicz, RJ Fontana, FV Schiødt, A Larson, TJ Davern, SHB Han, TM McCashland, AO Shakil, JE Hay, L Hynan, JS Crippin, AT Blei, G Samuel, J Reisch, WM Lee, and the U.S. Acute Liver Failure Study Group.

Why did the researchers do this particular study?

Acute liver failure is a potentially deadly condition that affects about 2000 Americans each year. Most often, liver failure develops over a period of years as an insult to the liver (such as alcohol abuse or infection with hepatitis virus) slowly damages it. Less commonly, liver failure is acute, meaning that it occurs over a period of days or weeks. The things that can cause acute liver failure include hepatitis virus infections, drugs, pregnancy, autoimmune disease, and sudden low blood flow to the liver. Little is known about how often each of these things is responsible for acute liver failure in the United States. Information about the causes and outcomes of acute liver failure would be helpful to doctors who care for patients with this condition.

Who was studied?

308 patients with acute liver failure who received care between January 1998 and May 2001 at 1 of 17 U.S. medical centers that specialize in liver disease. All patients were 15 years of age or older.

How was the study done?

Each of the 17 participating centers kept careful records of patients' information, including the cause of the liver failure, physical examination and laboratory findings, and information about how the patients were doing 3 weeks after they first presented to a study center. The researchers used this information to determine the frequency of the various causes of acute liver failure. They also looked for associations among patient characteristics, cause of liver failure, and patient outcomes.

What did the researchers find?

The most frequent causes of acute liver failure were overdose of acetaminophen (an over-the-counter pain and fever medicine), other drug reactions, and hepatitis A or B virus infection. In 17% of cases, the cause was unknown. At 3 weeks, 67% of the patients were alive. Of the patients who were alive at 3 weeks, 29% had undergone a liver transplantation. Survival varied greatly with cause. Of the patients with acetaminophen overdose who had not received a liver transplant, 68% were alive at 3 weeks compared with only 17% who had liver failure of unknown cause. Older age and being in a coma at the time of presentation were also associated with worse outcomes.

What were the limitations of the study?

The patients with acute liver failure at the 17 specialized centers in this study may be different from those who get care at other places.

What are the implications of the study?

In the United States, drugs, particularly acetaminophen, seem to be a more common cause of acute liver disease than hepatitis infection or other conditions. However, this study does not suggest that acetaminophen taken in recommended doses is dangerous to the liver. Among patients with acute liver failure in this study, those with acetaminophen overdose and those who were not in comas fared best.