• Stephen Warrillow, Michael Bailey, David Pilcher, Alex Kazemi, Colin McArthur, Paul Young, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Health, Melbourne, Australia.
• Intern Med J. 2019 Jul 1; 49 (7): 874-885.

BackgroundKnowledge about patients with acute liver failure (ALF) in Australia and New Zealand (ANZ) is lacking.AimsTo evaluate whether the pattern of ALF would be similar to previous studies and whether, despite potentially low transplantation rates, mortality would be comparable.MethodsWe obtained data from the ANZ Intensive Care Society Adult Patient Database and the ANZ Liver Transplant Registry for 10 years commencing 2005 and analysed for patient outcomes.ResultsDuring the study period, 1 022 698 adults were admitted to intensive care units across ANZ, of which 723 had ALF. The estimated annual incidence of ALF over this period was 3.4/million people and increased over time (P = 0.001). ALF patients had high illness severity (Acute Physiology And Chronic Health Evaluation III 79.8 vs 50.1 in non-ALF patients; P < 0.0001) and were more likely to be younger, female, pregnant and immunosuppressed. ALF was an independent predictor of mortality (odds ratio 1.5 (1.26-1.79); P < 0.0001). At less than 23%, the use of liver transplantation was low, but the mortality of 39% was similar to previous studies.ConclusionsALF is a rare but increasing diagnosis in ANZ intensive care units. Low transplantation rates in ANZ for ALF do not appear to be associated with higher mortality rates than reported in the literature.© 2019 Royal Australasian College of Physicians.

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