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Acute liver failure
Background
Overview
Definition
ALF is a disease characterized by an acute impairment of liver function, leading to encephalopathy and coagulopathy. Hyperacute, acute, and subacute types of liver failure are defined as occurring within 7 days, 7-28 days, and 28 days-6 months of the onset of symptoms, respectively.
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Pathophysiology
Causes of ALF include acetaminophen poisoning, viral hepatitis (hepatitis A, B, C, D, and E, HSV, Ebstein-Barr virus, CMV), AIH, idiosyncratic toxins (tetracycline, halothane, isoniazid, anabolic steroids, phytopharmaceuticals), Wilson's disease, fatty liver of pregnancy, and Budd-Chiari syndrome.
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Epidemiology
The annual incidence of ALF is estimated at approximately 0.55-0.62 cases per 100,000 person-years.
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Disease course
In patients with ALF, apoptosis and necrosis of parenchymal hepatocytes impairs normal liver function, resulting in coagulopathy, hepatic encephalopathy, multiple organ failure, and death.
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Prognosis and risk of recurrence
The hospital survival rates of ALF patients treated with liver transplantation and without liver transplantation are 80-86% and 35-48%, respectively.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acute liver failure are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG 2023), the Society of Critical Care Medicine (SCCM 2023,2020), the American Society for Apheresis (ASFA 2019), the American Gastroenterological Association (AGA 2017), and the European Association for the Study of the ...
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