Koch A, Trautwein C, Tacke F
Medizinische Klinik III, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Med Klin Intensivmed Notfmed. 2017 May;112(4):371-381. doi: 10.1007/s00063-017-0282-0. Epub 2017 Apr 25.
Acute liver failure (ALF) is a rare, but life-threatening disease that is characterized by the acute onset of jaundice, coagulopathy, and hepatic encephalopathy (HE) in patients without pre-existing liver disease. Main causes in Germany are drug toxicity, acetaminophen overdose, and viral hepatitis (A, B, E). For the initial assessment of patients with ALF and the diagnostic algorithm, the early detection of HE, exclusion of liver cirrhosis, immediate diagnosis of the underlying etiology, and evaluation for the necessity of liver transplantation (LT) are critical. Intensive care therapeutic measures aim at preventing or treating complications of ALF. Potentially, plasmapheresis (full plasma exchange) offers a survival benefit for ALF patients who do not undergo LT. The King's College criteria and the Clichy criteria are used as prognostic tools for the indication for LT.
急性肝衰竭（ALF）是一种罕见但危及生命的疾病，其特征是既往无肝病的患者急性出现黄疸、凝血功能障碍和肝性脑病（HE）。在德国，主要病因是药物毒性、对乙酰氨基酚过量和病毒性肝炎（甲型、乙型、戊型）。对于ALF患者的初始评估和诊断流程，早期发现HE、排除肝硬化、立即诊断潜在病因以及评估肝移植（LT）的必要性至关重要。重症监护治疗措施旨在预防或治疗ALF的并发症。血浆置换（全血浆置换）可能为未接受LT的ALF患者带来生存益处。国王学院标准和克利希标准被用作LT指征的预后工具。
