Key Points
ÎAcute liver failure (ALF) is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in individuals without known preexisting liver disease. U.S. estimates are placed at approximately 2000 cases per year.
ÎThe most prominent causes include drug-induced liver injury, viral hepatitis, autoimmune liver disease and shock or hypoperfusion. Many cases (~ 15%) have no discernible cause.
ÎAcute liver failure often affects young persons and carries a high morbidity and mortality. Prior to transplantation, most series suggested less than 15% survival. Currently, overall short-term survival (one year) including those undergoing transplantation is greater than 65%.
ÎNo single therapy has been found to improve the outcome of all patients with ALF, with the possible exception of N-acetylcysteine (NAC).
Definitions
ÎThe most widely accepted definition of ALF includes evidence of coagulation abnormality, usually an International Normalized Ratio (INR) ≥ 1.5, and any degree of mental alteration (encephalopathy) in a patient without preexisting cirrhosis and with an illness of < 26 weeks' duration.
ÎPatients with Wilson disease, vertically-acquired hepatitis B virus (HBV), or autoimmune hepatitis may be included in spite of the possibility of cirrhosis if their disease has been recognized for < 26 weeks.
