• Johannes Hadem, Frank Tacke, Tony Bruns, Julia Langgartner, Pavel Strnad, Gerald U Denk, Panagiotis Fikatas, Michael P Manns, Wolf P Hofmann, Guido Gerken, Frank Grünhage, Andreas Umgelter, Christian Trautwein, Ali Canbay, and Acute Liver Failure Study Group Germany.
• Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany. hadem.johannes@mh-hannover.de
• Clin. Gastroenterol. Hepatol. 2012 Jun 1;10(6):664-9.e2.

Background & AimsAcute liver failure (ALF) is a severe form of acute liver injury that can progress to multiple organ failure. We investigated causes and outcomes of ALF.MethodsEleven university medical centers in Germany were asked to report patients with (primary) severe acute liver injury (sALI) (international normalized ratio [INR] >1.5 but no hepatic encephalopathy) and primary ALF (INR >1.5 with overt hepatic encephalopathy) treated from 2008 to 2009. Data were analyzed from 46 patients with sALI and 109 patients with ALF.ResultsThe most frequent etiologies of primary ALF were non-acetaminophen drug-induced (32%), indeterminate (24%), and viral (21%); acetaminophen ingestion was the cause of ALF in only 9% of patients. The support of a ventilator was required by 44% of patients with ALF, vasopressors by 38%, and renal replacement by 36%. Seventy-nine patients with ALF (72%) survived until hospital discharge, 38 (35%) survived without emergency liver transplantation (ELT), and 51 received ELT (47%); 80% of patients who received ELT survived until discharge from the hospital.ConclusionsIn Germany, drug toxicity, indeterminate etiology, and viral hepatitis appear to be the major causes of primary ALF, which has high mortality. Patients with ALF are at great risk of progressing to multiple organ failure, but 80% of patients who receive ELT survive until discharge from the hospital.Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

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