• Pan Zhao, Chunya Wang, Weiwei Liu, Gang Chen, Xinying Liu, Xi Wang, Bao Wang, Liming Yu, Yanrong Sun, Xiaoming Liang, Haozhen Yang, and Fei Zhang.
• Liver Failure Therapy and Research Center, Beijing 302 Hospital (PLA 302 Hospital), Beijing, China.
• Plos One. 2013 Jan 1;8(11):e80991.

ObjectivesNo extensive investigation has been performed and thus no representative data are available regarding acute liver failure (ALF) in China. This study aims to investigate the causes and outcomes of ALF in China and establish a prognostic model.MethodsPatients diagnosed as ALF in seven hospitals in different areas of China from January 2007 to December 2012 were retrospectively selected.ResultsOf the 177 patients included in this study, 112 (63.28%) eventually died. The common causes of ALF were drug toxicity (43.50%), indeterminate etiology (29.38%) and acute viral hepatitis (11.30%). Additionally, traditional Chinese herbs predominated in the causes of drug-induced ALF (30/77). No patients in this study received liver transplantation. In the established model for predicting death in ALF, four variables were finally selected out, including age (P=0.01), the entry hepatic encephalopathy grade (P=0.04), international normalized ratio (P<0.01) and arterial blood ammonia (P=0.02). Using a threshold value of 0.5683, this model had a sensitivity of 95.24% and a specificity of 91.30%.ConclusionsTraditional Chinese medicine was a major cause of ALF in China. The spontaneous mortality of ALF was high, whereas the rate of liver transplantation was significantly low. The established prognostic model of ALF had superior sensitivity and specificity.

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