Haselwanter Patrick, Fairfield Seanna, Riedl-Wewalka Marlene, Schmid Monika, Stättermayer Albert Friedrich, Reiberger Thomas, Trauner Michael, Zauner Christian, Schneeweiss-Gleixner Mathias
Department of Medicine III, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2025 May 26. doi: 10.1007/s00508-025-02539-1.
Acute liver failure (ALF) is characterized by a rapid deterioration of liver function and a high mortality without transplantation depending on etiology and onset. Immediate transfer to a dedicated intensive care unit (ICU) and evaluation for high-urgency liver transplantation (HU-LTx) is recommended to maximize chances of survival. Data on ALF epidemiology are limited, particularly for Central Europe.
This retrospective single-center study included all ALF patients admitted to the ICU of the Department of Gastroenterology and Hepatology at the Vienna General Hospital between 2012 and 2024.
Overall, 31 patients (median age of 44 [interquartile range, IQR 32-56] years, 20 [65%] female) were included. The primary causes of ALF were viral infections (n = 8; 26%), autoimmune hepatitis (n = 5; 16%), drug-induced liver injury (DILI; n = 3; 10%), and Wilson's disease (n = 4; 13%), while in 8 patients (26%) no cause was identified. Median length of ICU stay was 12 (IQR 4-21) days, with mean sequential organ failure assessment (SOFA) and simplified acute physiology score II (SAPS II) scores of 10.55 ± 4.56 and 40.97 ± 14.84. Overall ICU survival was 61% (n = 19). Non-HU-LTx patients (n = 18) had an ICU survival of 44%. HU-LTx was performed in 13 patients (42%), with 12 patients (92%) surviving 28 days. The 6‑month overall survival of HU-LTx patients was 85%.
The diverse causes of ALF in Central Europe include most commonly viral infections, autoimmune hepatitis, and DILI. HU-LTx was required and performed in almost half of patients and was associated with favorable survival rates, underscoring the importance of ICU management and early transfer to liver transplantation centers in the management of ALF.
急性肝衰竭（ALF）的特征是肝功能迅速恶化，若不进行移植，其死亡率较高，具体取决于病因和发病情况。建议立即转至专门的重症监护病房（ICU）并评估是否需要进行高紧急度肝移植（HU-LTx），以最大程度提高生存几率。关于ALF流行病学的数据有限，尤其是在中欧地区。
这项回顾性单中心研究纳入了2012年至2024年间维也纳总医院胃肠病学和肝病科ICU收治的所有ALF患者。
总共纳入了31例患者（中位年龄44岁[四分位间距，IQR 32 - 56]，20例[65%]为女性）。ALF的主要病因包括病毒感染（n = 8；26%）、自身免疫性肝炎（n = 5；16%）、药物性肝损伤（DILI；n = 3；10%）和威尔逊病（n = 4；13%），而8例患者（26%）未查明病因。ICU住院时间中位数为12天（IQR 4 - 21），序贯器官衰竭评估（SOFA）平均得分和简化急性生理学评分II（SAPS II）分别为10.55±4.56和40.97±14.84。ICU总体生存率为61%（n = 19）。非HU-LTx患者（n = 18）的ICU生存率为44%。13例患者（42%）接受了HU-LTx，其中12例患者（92%）存活28天。HU-LTx患者的6个月总体生存率为85%。
中欧地区ALF的病因多样，最常见的包括病毒感染、自身免疫性肝炎和DILI。近一半患者需要并接受了HU-LTx，且生存率良好，这凸显了ICU管理以及早期转至肝移植中心在ALF管理中的重要性。
