Adukauskiene Dalia, Dockiene Ilona, Naginiene Rima, Kevelaitis Egidijus, Pundzius Juozas, Kupcinskas Limas
Department of Intensive Care, Kaunas University of Medicine, Kaunas, Lithuania.
Medicina (Kaunas). 2008;44(7):536-40.
Acute liver failure (ALF) is a life-threatening condition that can rapidly progress into coma and death due to the cerebral edema and multi-organ dysfunction. The ALF etiology and risk factors have been investigated in West Europe, North America, and Asia; however, there are still no published data about the causes and prognosis of ALF in Central and East European countries. The aim of our study was to analyze the causes, outcomes, and prognostic factors of ALF in patients referred to tertiary care center in Lithuania.
A total of 28 consecutive patients admitted to the tertiary care center (one of two university-level medical centers in Lithuania) over the period of January 1996 and December 2004 and who fulfilled the entry criteria of ALF (presence of hepatic encephalopathy (HE) and prothrombin international normalized ratio (INR) >1.5) were included into a prospective study.
In our study the most frequent causes of ALF were acute viral hepatitis B (21.4 %), drug-induced hepatitis (21.4%), and indeterminate hepatitis (17.9%); other etiologies included Budd-Chiari syndrome (10.7%), ischemic hepatitis (10.7%), Wilson's disease (7.1%), Amanita phalloides-induced liver damage (3.6%), acute fatty liver of pregnancy (3.6%), and malignant infiltration of the liver (3.6%). Among patients with drug-induced liver injury, only one case of acetaminophen poisoning was diagnosed. Clinical status of 9 persons in all patients with ALF corresponded to criteria for liver transplantation (LT) (one liver transplantation was performed), 6 of them had contraindications, and 13 patients did not fulfill requirements for urgent LT. The patients' survival rate in these groups was 11.1%, 16.7% and 69.2%, respectively. In 27 non-transplanted patients univariate analysis revealed the grade of HE on the day of enrolment, total serum bilirubin, pH, and prothrombin INR as risk factors for death from ALF. Multivariate logistic regressive analysis determined only prothrombin INR >3.24 and serum pH <or=7.29 as independent predictors of lethal outcome in ALF.
Acute viral hepatitis B, drug-induced liver injury, and indeterminate hepatitis are the main ALF causes in Lithuania. In non-transplanted patients, the main predictors of lethal outcome were severe coagulopathy and metabolic acidosis. Improvement of liver donation system for urgent liver transplantation is essential requirement for amelioration of ALF patient's survival.
急性肝衰竭（ALF）是一种危及生命的疾病，可因脑水肿和多器官功能障碍迅速发展为昏迷和死亡。西欧、北美和亚洲已对ALF的病因和危险因素进行了研究；然而，中东欧国家关于ALF的病因和预后仍无公开数据。我们研究的目的是分析转诊至立陶宛三级医疗中心的ALF患者的病因、结局和预后因素。
1996年1月至2004年12月期间，共有28例连续入住三级医疗中心（立陶宛两所大学级医疗中心之一）且符合ALF纳入标准（存在肝性脑病（HE）且凝血酶原国际标准化比值（INR）>1.5）的患者纳入一项前瞻性研究。
在我们的研究中，ALF最常见的病因是急性乙型病毒性肝炎（21.4%）、药物性肝炎（21.4%）和不明原因肝炎（17.9%）；其他病因包括布加综合征（10.7%）、缺血性肝炎（10.7%）、威尔逊病（7.1%）、毒蕈中毒性肝损伤（3.6%）、妊娠急性脂肪肝（3.6%）和肝脏恶性浸润（3.6%）。在药物性肝损伤患者中，仅诊断出1例对乙酰氨基酚中毒。所有ALF患者中有9人的临床状况符合肝移植（LT）标准（进行了1例肝移植），其中6人有禁忌证，13例患者不符合紧急LT的要求。这些组患者的生存率分别为11.1%、16.7%和69.2%。在27例未接受移植的患者中，单因素分析显示入院当天的HE分级、总血清胆红素、pH值和凝血酶原INR是ALF死亡的危险因素。多因素逻辑回归分析仅确定凝血酶原INR>3.24和血清pH值≤7.29是ALF致死结局的独立预测因素。
急性乙型病毒性肝炎、药物性肝损伤和不明原因肝炎是立陶宛ALF的主要病因。在未接受移植的患者中，致死结局的主要预测因素是严重凝血功能障碍和代谢性酸中毒。改善紧急肝移植的肝脏捐赠系统是改善ALF患者生存率的基本要求。
