Ostapowicz George, Fontana Robert J, Schiødt Frank V, Larson Anne, Davern Timothy J, Han Steven H B, McCashland Timothy M, Shakil A Obaid, Hay J Eileen, Hynan Linda, Crippin Jeffrey S, Blei Andres T, Samuel Grace, Reisch Joan, Lee William M
Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
Ann Intern Med. 2002 Dec 17;137(12):947-54. doi: 10.7326/0003-4819-137-12-200212170-00007.
Because acute liver failure is rare, related data have been sparse. Studies have suggested that viral hepatitis is the most common underlying cause of this condition.
To describe the clinical features, presumed causes, and short-term outcomes of acute liver failure.
Prospective cohort study.
17 tertiary care centers participating in the U.S. Acute Liver Failure Study Group.
308 consecutive patients with acute liver failure, admitted over a 41-month period.
Detailed clinical and laboratory data collected during hospitalization, including outcome 3 weeks after study admission.
73% of patients were women; median age was 38 years. Acetaminophen overdose was the most common apparent cause of acute liver failure, accounting for 39% of cases. Idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent of patients had liver transplantation, and 43% survived without transplantation. Short-term transplant-free survival varied greatly, from 68% for patients with acetaminophen-related liver failure to 25% and 17% for those with other drug reactions and liver failure of indeterminate cause, respectively. Coma grade at admission appeared to be associated with outcome, but age and symptom duration did not.
Acetaminophen overdose and idiosyncratic drug reactions have replaced viral hepatitis as the most frequent apparent causes of acute liver failure. Apparent cause and coma grade at admission were associated with outcome. Although transplantation may improve patient survival, it was unavailable or unnecessary for most patients.
由于急性肝衰竭较为罕见，相关数据一直较少。研究表明，病毒性肝炎是导致这种情况的最常见潜在病因。
描述急性肝衰竭的临床特征、推测病因及短期预后。
前瞻性队列研究。
17家参与美国急性肝衰竭研究组的三级医疗中心。
在41个月期间连续收治的308例急性肝衰竭患者。
住院期间收集的详细临床和实验室数据，包括研究入组3周后的预后情况。
73%的患者为女性；中位年龄为38岁。对乙酰氨基酚过量是急性肝衰竭最常见的明显病因，占病例的39%。特异质性药物反应为推测病因的占13%，甲型和乙型病毒性肝炎合并占12%，17%的病例病因不明。3周时患者总体生存率为67%。29%的患者接受了肝移植，43%未接受移植而存活。无移植的短期生存率差异很大，对乙酰氨基酚相关性肝衰竭患者为68%，其他药物反应和病因不明的肝衰竭患者分别为25%和17%。入院时的昏迷分级似乎与预后相关，但年龄和症状持续时间无关。
对乙酰氨基酚过量和特异质性药物反应已取代病毒性肝炎，成为急性肝衰竭最常见的明显病因。明显病因和入院时的昏迷分级与预后相关。尽管移植可能提高患者生存率，但对大多数患者来说无法获得或不必要。
Zotero 插件