Population-based surveillance for acute liver failure
Population-based surveillance for acute liver failure
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DOI：
10.1111/j.1572-0241.2007.01388.x
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发表时间：
2007-11-01
影响因子：
9.8
通讯作者：
Bell, Beth P.
中科院分区：
文献类型：
--
作者：
Bower, William A.;Johns, Matthew;Bell, Beth P.
目的：大多数美国急性肝衰竭（ALF）患者的研究都是在三级护理肝移植中心进行的。本研究的目的是进行以人口为基础的监测ALF.Methods：我们进行了以人口为基础的监测ALF在8个县，包括2000年11月和2004年10月之间的大都会亚特兰大。ALF病例定义为存在凝血功能障碍，发病26周内出现任何级别的肝性脑病，且无基础肝病史。一份问卷调查管理和医疗记录进行了审查，以确定临床特征，病因，和outcomes.Results：共65例被招募，产生每年的发病率为5.5（95%CI 4.3-7.0）每百万ALF的所有原因。对乙酰氨基酚（APAP）相关ALF是成人中最常见的（41%）病因，而病因不明的ALF在儿童中最常见（38%），其次是APAP相关ALF（25%）。意外APAP过量是APAP相关原因中最常见的类型（61%）。与其他种族相比，黑人更可能患有病因不明的ALF（32%对11%）。总体死亡率为40%，27（42%）生存与支持性治疗单独和8（12%）需要原位肝transplantation.Conclusions：我们的人口为基础的研究表明，大约1,600 ALF的情况下，发生在美国每年。与仅在肝移植中心进行的研究结果一致，APAP相关ALF是最常见的病因。医学界对APAP相关ALF的认识增加可能会限制未来的病例。对于病因不明的ALF，尤其是儿童ALF，需要进行更多的研究。
Objectives: Most U.S. studies of acute liver failure (ALF) patients have been conducted at tertiary care liver transplantation centers. The aim of this study was to conduct population-based surveillance for ALF.Methods: We conducted population-based surveillance for ALF within the 8 counties comprising Metropolitan Atlanta between November 2000 and October 2004. ALF cases were defined as the presence of coagulopathy, any grade of hepatic encephalopathy within 26 wk of illness onset, and no history of underlying liver disease. A questionnaire was administered and medical records were reviewed to determine clinical features, etiologies, and outcomes.Results: A total of 65 cases were enrolled, yielding an annualized incidence for all causes of ALF of 5.5 (95% CI 4.3-7.0) per million. Acetaminophen (APAP)-related ALF was the most common (41%) etiology in adults while ALF of undetermined etiology was most common (38%) in children, followed by APAP-related ALF (25%). Unintentional APAP overdose was the most common type (61%) of APAP-related cause. Blacks were more likely than other races to have ALF of undetermined etiology (32% vs 11%). Overall mortality was 40%, with 27 (42%) surviving with supportive care alone and 8 (12%) requiring orthotopic liver transplantation.Conclusions: Our population-based study suggests approximately 1,600 ALF cases occur in the United States each year. Consistent with findings from studies conducted exclusively at liver transplantation centers, APAP-related ALF was the most common etiology. Increased awareness of APAP-related ALF in the medical community may limit future cases. More research is warranted into ALF of undetermined etiology, especially in children.