Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States
Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States
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DOI：
10.7326/0003-4819-137-12-200212170-00007
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发表时间：
2002-12-17
影响因子：
39.2
通讯作者：
Lee, WM
中科院分区：
文献类型：
--
作者：
Ostapowicz, G;Fontana, RJ;Lee, WM
背景：由于急性肝衰竭很少见，因此相关数据很少。研究表明，病毒性肝炎是这种情况最常见的根本原因。目的：描述急性肝衰竭的临床特征、推测原因和短期结果。设计：前瞻性队列研究。地点：参与美国急性肝衰竭研究组的 17 个三级护理中心。患者：308 名连续 41 个月内入院的急性肝衰竭患者 测量：住院期间收集的详细临床和实验室数据，包括研究入院后 3 周的结果。结果：73% 的患者为女性；中位年龄为 38 岁。对乙酰氨基酚过量是急性肝衰竭最常见的明显原因，占病例的 39%。 13% 的病例推测原因为特异药物反应，12% 的病例涉及甲型和乙型病毒性肝炎合并，17% 的病例原因不明。 3 周时患者的总体生存率为 67%。 29% 的患者接受了肝移植，43% 的患者在没有移植的情况下存活下来。短期无移植生存率差异很大，对乙酰氨基酚相关肝衰竭患者的短期无移植生存率为 68%，而有其他药物反应和不明原因肝衰竭的患者分别为 25% 和 17%。入院时的昏迷程度似乎与结果相关，但年龄和症状持续时间并不相关。结论：对乙酰氨基酚过量和特殊药物反应已取代病毒性肝炎，成为急性肝衰竭最常见的明显原因。入院时的明显原因和昏迷等级与结果相关。尽管移植可以提高患者的生存率，但对大多数患者来说无法或没有必要。
Background: Because acute liver failure is rare, related data have been sparse. Studies have suggested that viral hepatitis is the most common underlying cause of this condition.Objective: To describe the clinical features, presumed causes, and short-term outcomes of acute liver failure.Design: Prospective cohort study.Setting: 17 tertiary care centers participating in the U.S. Acute Liver Failure Study Group.Patients: 308 consecutive patients with acute liver failure, admitted over a 41-month period.Measurements: Detailed clinical and laboratory data collected during hospitalization, including outcome 3 weeks after study admission.Results: 73% of patients were women; median age was 38 years. Acetaminophen overdose was the most common apparent cause of acute liver failure, accounting for 39% of cases. idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent of patients had liver transplantation, and 43% survived without transplantation. Short-term transplant-free survival varied greatly, from 68% for patients with acetaminophen-related liver failure to 25% and 17% for those with other drug reactions and liver failure of indeterminate cause, respectively. Coma grade at admission appeared to be associated with outcome, but age and symptom duration did not.Conclusions: Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as the most frequent apparent causes of acute liver failure. Apparent cause and coma grade at admission were associated with outcome. Although transplantation may improve patient survival, it was unavailable or unnecessary for most patients.