Epidemiology and outcomes of acute liver failure in Australia
Epidemiology and outcomes of acute liver failure in Australia
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DOI：
10.4254/wjh.v11.i7.586
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发表时间：
2019-07-27
影响因子：
2.4
通讯作者：
Gow, Paul
中科院分区：
文献类型：
--
作者：
Hey, Penelope;Hanrahan, Timothy P.;Gow, Paul
背景急性肝衰竭（ALF）是一种危及生命的综合征，其病因各异，需要复杂的护理和多学科管理。澳大利亚过去 16 年中其发病率、病因和结果的变化仍不确定。目的描述澳大利亚东南部 ALF 的发病率、病因和结果的变化。方法查阅维多利亚肝移植单位的数据库，以确定 2002 年 1 月至 2017 年 12 月期间住院的成人（> 16 岁）中所有 ALF 病例。总体而言，确定了 169 名符合 ALF 标准的患者。收集所有患者的人口统计学、ALF 病因、移植率和结果。根据出院生存率评估无移植生存率和总生存率（OS）。将结果与同一单位1988-2001年历史队列的数据进行比较。结果扑热息痛是急性肝衰竭最常见的病因，占病例的50%，与历史队列相比，发病率有所增加（P = 0.046）。病毒性肝炎和非扑热息痛药物或毒素引起的肝损伤分别占病例的15%和10%。与历史队列相比，无移植生存率 (TFS) 显着改善（52% vs 38%，P = 0.032）。 TFS 的扑热息痛毒性最高，72% 的病例可自行恢复，而非扑热息痛 ALF 的这一比例为 31%（P < 0.001）。 59 名患者被列入紧急肝移植的候补名单。其中九人在等待器官可用时死亡。 42 名患者 (25%) 接受了紧急肝移植，1 年、3 年和 5 年生存率分别为 81%、78% 和 72%。 结论 扑热息痛毒性是澳大利亚东南部 ALF 最常见的病因，且发病率在 30 年来不断上升。 TFS 有所改善，但非扑热息痛 ALF 中的 TFS 仍然较低。
BACKGROUNDAcute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain.AIMTo describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.METHODSThe database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988-2001.RESULTSParacetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively.CONCLUSIONParacetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.