Acute liver failure prognosis

The prognosis of HE with acute liver failure is generally very bad. Lethality is 80-85% this can diminish or increase, depending on the acuteness and severity of liver cell disintegration. (1, 2, 14, 20, 39, 113)... 

In endogenous hepatic coma (= due to loss of liver parenchyma), which in most cases develops from an existing chronic liver disease ( acute on chronic ), the prognosis is better than for acute liver failure, but nevertheless remains extremely poor. According to the information available in the relevant literature, 10-20% of patients die in stage I and 40-50% in stage II in stages III and IV, lethality is 80-90%, the same rate as in acute liver failure, (see chapter 20)... 

Tab. 20.1 Characteristics and prognosis of acute liver failure and its subtypes (modified according to J.G. O Grady et af, 1993) (N = normal)...

The course taken by acute liver failure varies in each case as a result of the respective complications, which also decidedly worsen the prognosis. Close-meshed and targeted laboratory investigations can usually identify... 

The prognosis is determined by the early onset of acute liver failure in the newborn and, in the following months or years, by the development of hepatocellular carcinoma. (163, 167) A liver transplantation is thus recommended as from the second or third year of life. (162) Dietary measures (avoidance of methionine, tyrosine and phenylalanine as nutritional components) have not proved particularly successful. Good therapeutic results were achieved when 2-(2-nitro-4-trifluoromethyl-benzoyl)-l-3-cyclohexanedione) (NTBC) was applied. This substance is an inhibitor of 4-hydroxyphenylpyru-vate dioxygenase, which prevents the accumulation of succinylacetone. (165) Even the risk of HCC development was reduced by this substance. 

Thus, TCD monitoring in patients with acute liver failure may be helpful in the detection of ICP alterations and may also provide cues to estimate the prognosis of an individual patient. Further studies, however, are needed to evaluate the prognostic significance of TCD monitoring in acute Uver failure. 

Prognosis of acute liver failure depends on several factors like etiology of liver disease, age, grade of liver disease, grade of encephalopathy, presence or absence of systemic inflammatory response syndrome, etc. Currently available prognostic scoring systems do not adequately predict outcomes or determine candidacy for liver transplantation (Poison and Lee, 2005). In the smdy of Bhatia et al. (2006), however, three variables were found to be significantly predictive of death arterial ph > 7.40, presence of clinical cerebral edema, and arterial ammonia levels > 124 [imol/1. 

Kumar R, Shalimar, Bhatia V, Khanal S, Sreenivas V, Gupta SD, Panda SK, Acharya SK. Antituberculosis therapy-induced acute liver failure magnitude, profile, prognosis, and predictors of outcome. Hepatology 2010 51(5) 1665-74. 

B. After 24-48 hours, when transaminase levels (AST and ALT) begin to rise, hepatic necrosis becomes evident. If acute fulminant hepatic failure occurs, death may ensue. Encephalopathy, metabolic acidosis, and a continuing rise in the prothrombin time (PT) indicate a poor prognosis. Acute renal failure occasionally occurs, with or without concomitant liver failure. 

The important uses of laboratory tests in acute hepatitis are to identify individuals with fulminant hepatic failure, document recovery, and determine clearance of any infectious agents. The most important tests in determining extent of injury are not plasma activities of cytosolic enzymes, but evidence of impaired liver function. The most important indicator of prognosis in acute hepatitis is impairment in synthetic functions of which PT is a widely accepted indicator. In acute viral or alcoholic hepatitis, PT more than 15... 

---