The incidence, etiologies, outcomes, and predictors of mortality of acute liver failure in Thailand: a population-base study

Kessarin Thanapirom,Sombat Treeprasertsuk,Massimo Pinzani,Kamthorn Phaosawasdi,Roongruedee Chaiteerakij,Piyawat Komolmit,Ngamphol Soonthornworasiri,Kittiyod Poovorawan

doi:10.1186/s12876-019-0935-y

Abstract

BackgroundAcute liver failure (ALF) is uncommon but progresses rapidly with high mortality. We investigated the incidence, etiologies, outcomes, and predictive factors for 30-day mortality in patients with ALF.MethodsWe conducted a population-based study of ALF patients hospitalized between 2009 and 2013 from the Thai Nationwide Hospital Admission database, which comprises 76% of all admissions from 858 hospitals across 77 provinces in Thailand. ALF was diagnosed using ICD-10 codes K72.0 and K71.11. Patients with liver cirrhosis were excluded.ResultsThere were 20,589 patients diagnosed with ALF during the study period with 12,277 (59.6%) males and mean age of 46.6 ± 20.7 years. The incidence of ALF was 62.9 per million population per year. The most frequent causes of ALF were indeterminate (69.4%), non-acetaminophen drug-induced (26.1%), and viral hepatitis (2.5%). Acetaminophen was the presumptive cause in 1.7% of patients. There were 5502 patients (26.7%) who died within 30 days after admission. One patient (0.005%) underwent liver transplantation. The average hospital stay was 8.7 ± 13.9 days, and the total cost of management was 1075.2 ± 2718.9 USD per admission. The most prevalent complications were acute renal failure (ARF)(24.2%), septicemia (18.2%), and pneumonia (12.3%). The most influential predictive factors for 30-day mortality were ARF (HR = 3.64, 95% CI: 3.43–3.87, p < 0.001), malignant infiltration of the liver (HR = 3.37, 95% CI: 2.94–3.85, p < 0.001), and septicemia (HR = 1.96, 95%CI: 1.84–2.08, p < 0.001).ConclusionsALF patients have poor outcomes with 30-day mortality of 26.7% and high economic burden. Indeterminate etiology is the most frequent cause. ARF, malignant infiltration of the liver, and septicemia are main predictors of 30-day mortality.

Highlights

Acute liver failure (ALF) is uncommon but progresses rapidly with high mortality
We investigated the demographic data, co-morbidities, causes of ALF, therapeutic procedures, clinical outcomes, and medical expense of ALF patients enrolled in the National Health Security Office (NHSO) database during these 5-year period
ALF patients who died within 30 days after admission had greater age (51.7 ± 20.6 vs. 44.7 ± 20.4 years, p < 0.001), a greater proportion of males (63.0% vs. 58.4%, p < 0.001), more co-morbidities (28.9% vs. 16.8%, p < 0.001), and more cases of indeterminate cause (73.6% vs. 67.9%) compared to patients who survived within 30 days (Table 1)

Summary

Introduction

Acute liver failure (ALF) is uncommon but progresses rapidly with high mortality. Etiologies, outcomes, and predictive factors for 30-day mortality in patients with ALF. ALF is an uncommon condition, and the average incidence is approximately 5.5–6.2 people per milllion population per year [11, 12]. Thanapirom et al BMC Gastroenterology (2019) 19:18 often rapidly progress to multiorgan failure and have a high mortality rate. Emergency liver transplantation remains the only definitive treatment for patients who do not achieve spontaneous recovery. A minority of ALF patients (7–18%) could receive emergency liver transplantation [13,14,15]. The in-hospital survival rates of patients with ALF treated with and without liver transplantation are 80–86% and 35–48%, respectively [9, 15]

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