Outcome Of Liver Failure Research Articles

Predicting an unfavorable outcome in patients with liver failure associated with obstructive jaundice syndrome: a prospective observational study

INTRODUCTION: Specialized scales developed to assess survival and mortality of patients after liver transplantation have not been validated when applied to liver failure in the setting of obstructive jaundice. OBJECTIVE: To determine the prognostic value of multiparametric scoring scales and to identify predictors of unfavorable outcome in liver failure due to obstructive jaundice. MATERIALS AND METHODS: 53 patients with confirmed liver failure due to obstructive jaundice of benign etiology who underwent biliary decompression were included in this prospective, observational, single-center study. Depending on the outcome two groups were distinguished: with favorable (n = 27, 51 %) and with unfavorable outcome (n = 26, 49 %). The following time points were defined for the dynamic evaluation of the course of the disease: day 1, day 3, day 7, and day 11 after decompression. Statistical processing of the data was performed using IBM SPSS Statistics 22 software for social science data analysis. RESULTS: The sensitivity and specificity of the studied scales in predicting liver failure due to obstructive jaundice were calculated on the basis of receiver operating characteristic (ROC) analysis. The AUROC for the SOFA was 0.862, for the MELD — 0.882, for the APACHE II — 0.864, for the Child-Turcotte-Pugh — 0.813. The sensitivity and specificity values for the SOFA were 78.9 and 77.8 %, for the MELD — 80.8 and 79.7 %, for the APACHE II — 57.7 and 81.9 %, and for the Child-Turcotte-Pugh — 75.1 and 70.9 %, respectively. Albumin was an independent predictor of unfavorable outcome (AUC ROC 0.909, p = 0.01), sensitivity 88.6 %, specificity 85.2 %. CONCLUSIONS: The scales presented in the study and the biomarker candidate “albumin” showed significant prognostic ability, but low values of sensitivity and specificity (less than 80 %) in some points of the study require the search for additional predictors of unfavorable outcome of liver failure due to obstructive jaundice.

Acute-On-Chronic Liver Failure-Outcome and Its Predictors in A Tertiary Care Hospital

Objective: To determine the characteristics and outcome of acute-on-chronic liver failure patients being managed at PakEmirates Military Hospital Rawalpindi.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Gastroenterology at Pak-Emirates Military Hospital, Rawalpindi, from Sep 2018 to Jan 2021.
 Methodology: In this study, 1559 patients diagnosed with cirrhosis were studied. Patients with pre-existing chronic kidney disease, chronic obstructive pulmonary disease, cardiac failure, dementia, and stroke were excluded. All the relevant features of each case were recorded in the proforma.
 Results: Out of 1559 patients, 67 had Acute-on-chronic liver failure. The majority of patients who presented with acute-onchronic liver failure were in grade Ib (55%), followed by grade II (30%). Hepatitis C virus related liver cirrhosis was the commonest underlying liver disease (78.4%). Drugs were the commonest triggering factor (33%), followed by acute viral hepatitis (27%). However, a large number of patients had no identifiable cause (25.4%).
 Conclusion: Acute-chronic-liver failure is common in patients presenting with acute decompensation of liver cirrhosis. Patients undergoing liver transplantation in the correct window period, have good prognosis.

Changing etiologies and outcome of liver failure in Southwest China.

BackgroundThe prognosis of liver failure depends greatly on the underlying cause, and there were few data about the prognosis, etiologies or trigger factors of liver failure in China based on long-term and large samples cohorts.MethodsWe screened out 3171 liver failure cases from 25467 patients hospitalized in our department between 2000 and 2012 according to Chinese criteria, and determined their etiologies and prognosis.Results97.3 % cases were associated with at least one of 25 identified factors. The 3 leading etiologies were HBV (91.6 %), alcohol (18.1 %) and antiviral therapy (AVT) related hepatitis B flares (6.7 %). Acute-on-chronic liver failure (ACLF) accounted for 92.1 % of all cases. 96.5 % ACLF cases were associated with HBV, in which the percentage of AVT related flares increased from 0 % in 2000 up to 11.5 % in 2012, and hepatitis virus superinfection declined from peak 19.3 % in 2002 down to 2.5 % in 2012. Three-month spontaneous survival (SS) rate of 3171 cases was 31.4 %, but improved from 17.4 % in 2000 up to 40.4 % in 2012. SS was significantly different among various etiological groups (P = 0.000). In HBV related liver failure aged 25 to 54 years, males accounted for 87.6 %, and had a progressively decreased SS with increasing age. From 25 to 54 years, SS was lower in male than in female HBV related liver failure, and having significant difference in cases of ages 40 to 44 years (27.6 % versus 50.9 %, P = 0.001).ConclusionEtiologies of liver failure were numerous and varied in southwest China. HBV was the most leading cause of liver failure, especially in ACLF. AVT related flares had become the third leading cause of ACLF. The prognosis of liver failure remained poor, but had markedly improved in recently 3 years. Middle-aged male HBsAg carriers had an extremely higher risk for liver failure and worse prognosis compared to female.Etiologies of liver failure were numerous and varied in southwest China. HBV infection is the main cause of liver failure in southwest China, especially the major cause of ACLF. Antiviral related liver failure, especially the NUCs withdrawal induced ACLF were extremely increased, which has replaced the superinfection as the third important cause of HBV-ACLF.The prognosis of liver failure is still poor, but the spontaneous survival rate showed a trend of steady rise in recent years. The prognosis of patients with liver failure caused by different causes also exists certain difference, the more damage factors bulls the worse prognosis.The prognosis of the HBV and HCV reactivation induced by the steroids was poor.Interferon treatment of CHB in ACLF although rare, but should be taken into consideration seriously.Patients with liver failure caused by different etiologies showed larger differences of gender and age distribution. Gender and age are the important factors with the occurrence and prognosis of HBV-ACLF.

Improvements in Acute Liver Failure Outcomes in the U.S.

To determine recent trends in causes, treatments, and outcomes of acute liver failure (ALF) in the U.S., researchers conducted an observational cohort

Predictors and outcomes of liver failure in severe hepatitis B reactivation

Predictors and outcomes of liver failure in severe hepatitis B reactivation

Different cell death mechanisms are triggered by acute or chronic right heart failure-induced liver failure

Background and Aims: Heart failure is a major issue in cardiologic patients and surgical interventions which can lead to liver failure (LF). The prognosis of LF due to right heart failure (RHF) depends on various factors like age of the patient, comorbidities, BMI and amount of cell death within the liver. However, course of liver failure and prognosis are hard to predict. The cytokeratin-18 (CK18) epitopes M65 and M30 are reported to distinguish between overall (necrotic) and apoptotic cell death, respectively. We investigated whether these cell death markers predict outcome of patients with RHF-induced LF and which cell death mechanism is predominant in each group. Methods: In a prospective study, 18 patients with LF on acute right heart failure (ARHF) and 23 patients with chronic right heart failure (CRHF) were included. Demographic and clinical parameters of the patients were collected and CK18/M65 and M30 ELISA was performed. M65 and M30 levels were correlated with outcome of liver failure, patient age and cause of liver failure. Results: Serum M65, representing overall cell death, in patients with ARHF-induced LF was significantly higher than in CRHF (19976.44±3364.63U/ml vs. 1283.29±138.43U/ml, p<0.0001). Absolute M30 (as marker of apoptosis) was also higher in patients with liver affection caused by ARHF as opposed to CRHF (3956.32±1147.97U/ml vs. 642.25±41.82U/ml, p=0.009). In contrast the M30/M65 ratio was significantly higher in CRHF than in ARHF patients (0.54±0.04 vs. 0.22±0.04, p<0.0001), indicating a greater contribution of apoptotic cell death in CRHF. Conclusions: The ratio of CK18 M30/M65 is a potential marker to discriminate between ARHF- induced and CRHF-induced liver failure and could probably be employed to predict outcome in patients with ARHF-induced LF.

Prometheus Versus Molecular Adsorbents Recirculating System: Comparison of Efficiency in Two Different Liver Detoxification Devices

Albumin dialysis by the molecular adsorbents recirculating system (MARS) and by fractionated plasma separation, adsorption, and dialysis (Prometheus[PROM]) represent novel nonbiological liver support systems specifically designed to remove albumin-bound substances. Preliminary evidence suggests a favorable impact of MARS on the course and outcome of liver failure. This study aimed at comparing the detoxification capacity of both devices. For this purpose, we performed a retrospective analysis on data prospectively collected in patients with acute-on-chronic liver failure treated with either the MARS (n = 9) or the PROM (n = 9) device on 2-5 consecutive days. Each treatment was performed for at least 5 h at identical blood and dialysate flows. Blood clearances were calculated during the first treatment session for urea nitrogen, creatinine, total bilirubin, and bile acids from paired arterial and venous line samples after 1, 4, and 6 h of treatment. Reduction ratios for all single-treatment sessions, and the overall treatment phase, were calculated from pretreatment and post-treatment values. For all markers but bile acids, the single-treatment as well as the overall treatment phase reduction ratios obtained with PROM were significantly higher compared with those obtained with MARS. PROM led at all time points to higher clearances for all evaluated solutes. Blood clearances of protein-bound substances declined over time with MARS, but not with PROM. In conclusion, a significant decline in the serum level of water-soluble and protein-bound toxins was achieved with both devices. PROM produces higher blood clearances for most toxins, which results in higher delivered treatment doses compared with a matching treatment with MARS.

The effects of early and late administration of inhibitors of inducible nitric oxide synthase in a thioacetamide-induced model of acute hepatic failure in the rat

Background/Aims: Nitric oxide (NO) is a pivotal mediator of inflammation. Its role in acute hepatic failure (AHF) is controversial. We investigated the role of NO, and the hypothesis that inhibition of inducible NO synthase (iNOS) activity would improve outcome in liver failure in rats, using the iNOS inhibitors l-NAME and aminoguanidine (AMG). Methods: AHF was induced by two intraperitoneal injections of thioacetamide (TAA). Seven groups ( n=10) were studied. Group I: TAA alone. Groups II, III and IV were additionally pre-treated with the NO precursor l-arginine (300 mg/kg i.p.), or iNOS inhibitors AMG (100 mg/kg s.c.), or N G-nitro- l-arginine methyl ester ( l-NAME) (100 mg/kg s.c.) for 5 days, respectively. Groups V, VI and VII received l-arginine, AMG or l-NAME commencing immediately after TAA administration. Clinical and biochemical parameters were assessed serially, and mortality investigated in further similar cohorts for each regime. Results: AMG, pre-treatment but not post-treatment, significantly improved outcome including mortality (10 vs. 70%, P<0.005). The less selective iNOS inhibitor l-NAME was not beneficial. Arginine pre-and post-treatment, and iNOS inhibition post-treatment, worsened clinical parameters of TAA-induced liver failure. Conclusions: Administration of the iNOS inhibitor AMG prior to insult reduces the severity of damage and improves mortality.

Extracorporeal support of the failing liver.

Successes in machine-based extracorporeal support for different organ functions stimulated research in the field of liver support approximately 50 years ago. Initial failure to improve outcome using detoxification methods like dialysis, blood and plasma exchange, or plasmapheresis over sorbents fueled interest in biologic liver support concepts using bioreactors or combined methods. New device configurations, technical improvement of existing detoxification methods, and the refinement in cell culture techniques led to a boost in research on biologic and nonbiologic approaches. Currently, many systems are in the preclinical phase or have entered clinical studies. A number of completed clinical trials have reported a favorable therapeutic impact of the most advanced solutions on the course and outcome of liver failure. Often, findings must be reconfirmed. However, current knowledge suggests that extracorporeal liver support can successfully stabilize liver function, improve the clinical condition of patients, and considerably improve survival in certain subgroups of patients with fulminant hepatic failure and acute decompensation of chronic hepatic failure. Although the initial focus of liver support methods was bridging to liver transplantation, bridging to recovery of organ function and treatment of intractable pruritus are now valuable indications.