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09-05-2024 | Acute Liver Failure | Narrative review

Overview of acute liver failure in India

Author: Subrat Kumar Acharya

Published in: Indian Journal of Gastroenterology | Issue 2/2024

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Abstract

Acute liver failure (ALF) is an infrequent, but serious complication subsequent to severe acute liver injury (sALI) due to various hepatotoxic agents such as hepatotropic virus(es) and drugs such as anti-tubercular medications, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics and anti-cancer and anti-epileptic therapy and due to metabolic and autoimmune disease flares. ALF after sALI presents with encephalopathy associated with prolonged international normalized ratio (INR). Mortality in ALF is high and ranges between 50% and 80%. Due to severe liver damage, multiple sequels consequent to hepatic dysfunction result in complications such as hyperammonemia that culminates in encephalopathy associated with cerebral edema; innate immune paralysis resulting in increased frequency of infections and endotoxemia causing decrease in systemic vascular resistance (SVR) and tissue hypoperfusion and damage-associated molecular patterns (DAMPs) released from damaged hepatic parenchyma inducing pro-inflammatory cytokine storm, which may cause other organ dysfunctions. Certain etiologies such as hepatitis E virus and hepatitis A virus-related ALF or paracetamol-ALF (hyper-acute presentation) have better survival than remaining causes. In addition, if etiology-specific treatment (antivirals for ALF related to hepatitis B virus (HBV) or Herpes simplex virus (HSV) or N-acetylcysteine for paracetamol) is available, then the outcome with treatment is better. About half of the patients can be salvaged with medical therapy. All patients need intensive care and organ support to provide time for the liver to regenerate. Various prognostic models to predict high probability of mortality have been described, which should be used to select patient early during the disease for liver transplantation, which is associated with high long-term survival in these sick patients. The Indian National Association for Study of the Liver (INASL) recommends the ALF-Early Dynamic (ALFED) model as a preferred prognostic model in the Indian scenario, where hepatitis viruses are a dominant etiology of ALF and occur on a naïve liver with good regenerative capacity.
Literature
2.
go back to reference Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of Liver (INASL) consensus paper on acute liver failure (part-1): epidemiology, pathogenesis, presentation and prognosis. J Clin Exp Hepatol. 2020;10:339–76.CrossRefPubMedPubMedCentral Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of Liver (INASL) consensus paper on acute liver failure (part-1): epidemiology, pathogenesis, presentation and prognosis. J Clin Exp Hepatol. 2020;10:339–76.CrossRefPubMedPubMedCentral
4.
go back to reference Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RAFM. Systemic review: acute liver failure – one disease, more than 40 definitions. Aliment Pharmacol Ther. 2012;35:1245–56.CrossRefPubMed Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RAFM. Systemic review: acute liver failure – one disease, more than 40 definitions. Aliment Pharmacol Ther. 2012;35:1245–56.CrossRefPubMed
5.
go back to reference Acharya SK. Acute liver failure: Indian perspective. Clin Liv dis. 2021;18:143–9.CrossRef Acharya SK. Acute liver failure: Indian perspective. Clin Liv dis. 2021;18:143–9.CrossRef
6.
go back to reference O’Grady JG, Schalm CW, Williams R. Acute liver failure; redefining the syndrome. Lancet. 1993;342:273–5.CrossRefPubMed O’Grady JG, Schalm CW, Williams R. Acute liver failure; redefining the syndrome. Lancet. 1993;342:273–5.CrossRefPubMed
7.
go back to reference Acharya SK, Panda SK, Saxena A, Gupta SD. Acute hepatic failure in India: a perspective from the East. J Gastroenterol Hepatol. 2000;15:473–9.CrossRefPubMed Acharya SK, Panda SK, Saxena A, Gupta SD. Acute hepatic failure in India: a perspective from the East. J Gastroenterol Hepatol. 2000;15:473–9.CrossRefPubMed
8.
go back to reference Acharya SK, Dasarathy S, Kumer TL, et al. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome. Hepatology. 1996;23:1448–55.CrossRefPubMed Acharya SK, Dasarathy S, Kumer TL, et al. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome. Hepatology. 1996;23:1448–55.CrossRefPubMed
9.
go back to reference Devarbhavi H, Joseph T, Sunil Kumar N, et al. The Indian network of drug-induced liver injury: etiology, clinical features, outcome and prognostic markers in 1288 patients. J Clinl and Exp Hepatol. 2021;11:288–98.CrossRef Devarbhavi H, Joseph T, Sunil Kumar N, et al. The Indian network of drug-induced liver injury: etiology, clinical features, outcome and prognostic markers in 1288 patients. J Clinl and Exp Hepatol. 2021;11:288–98.CrossRef
10.
go back to reference Bjornsson ES. Liver injury associated with drugs and complementary and alternative medicines in India (Editorial). J Clin and Exp Hepatol. 2021;11:281–3.CrossRef Bjornsson ES. Liver injury associated with drugs and complementary and alternative medicines in India (Editorial). J Clin and Exp Hepatol. 2021;11:281–3.CrossRef
12.
go back to reference Govindarajan R, Ramamoorthy G, Shanmugam RM, et al. Rodenticide ingestion is an important cause of hepatotoxicity in Tamilnadu, South India. Indian J Gastroenterol. 2021;40:373–9.CrossRefPubMed Govindarajan R, Ramamoorthy G, Shanmugam RM, et al. Rodenticide ingestion is an important cause of hepatotoxicity in Tamilnadu, South India. Indian J Gastroenterol. 2021;40:373–9.CrossRefPubMed
13.
go back to reference Shalimar Kedia S, Gunjan D, et al. Acute liver failure due to hepatitis E virus infection is associated with better survival than other etiologies in Indian patients. Dig Dis Sci. 2017;62:1058–68.CrossRefPubMed Shalimar Kedia S, Gunjan D, et al. Acute liver failure due to hepatitis E virus infection is associated with better survival than other etiologies in Indian patients. Dig Dis Sci. 2017;62:1058–68.CrossRefPubMed
14.
go back to reference Anand AC, Garg HK. Approach to clinical syndrome of jaundice and encephalopathy in tropics. J Clin Exp Hepatol. 2015;5 Suppl1:S116–30.CrossRef Anand AC, Garg HK. Approach to clinical syndrome of jaundice and encephalopathy in tropics. J Clin Exp Hepatol. 2015;5 Suppl1:S116–30.CrossRef
15.
go back to reference Phipps MM, Barraza LH, LaSota ED, et al. Acute liver injury in COVID-19: prevalence and association with clinical outcomes in a large U.S. cohort. Hepatology. 2020;72:807–17.CrossRefPubMed Phipps MM, Barraza LH, LaSota ED, et al. Acute liver injury in COVID-19: prevalence and association with clinical outcomes in a large U.S. cohort. Hepatology. 2020;72:807–17.CrossRefPubMed
18.
go back to reference Shawcross D, Deutz NEP, Damink OSWM, Jalan R. Hepatic encephalopathy in liver failure A multi organ perspective. In: Arroyo V, Forns X, Gracia-Pagan JC, Rodes J, editors. Progress in the treatment of liver disease. Barcelona: Ars Medica; 2003. p. 51–60. Shawcross D, Deutz NEP, Damink OSWM, Jalan R. Hepatic encephalopathy in liver failure A multi organ perspective. In: Arroyo V, Forns X, Gracia-Pagan JC, Rodes J, editors. Progress in the treatment of liver disease. Barcelona: Ars Medica; 2003. p. 51–60.
19.
20.
go back to reference Dethloff TJ, Knudsen GM, Larsen FS. Cerebral blood flow autoregulation in experimental liver failure. J Cereb Blood Flow Metab. 2008;28:916–26.CrossRefPubMed Dethloff TJ, Knudsen GM, Larsen FS. Cerebral blood flow autoregulation in experimental liver failure. J Cereb Blood Flow Metab. 2008;28:916–26.CrossRefPubMed
21.
go back to reference Rovengo M, Vera M, Ruiz A, Benitez C. Current concepts in acute liver failure. Ann Hepatol. 2019;18:543–53.CrossRef Rovengo M, Vera M, Ruiz A, Benitez C. Current concepts in acute liver failure. Ann Hepatol. 2019;18:543–53.CrossRef
22.
go back to reference Karvellas CJ, Pink F, McPhail M, Cross T, Auzinger G, Bernal W, Sizer E, Kutsogiannis DJ, Eltringham I, Wendon JA. Predictors of bacteraemia and mortality in patients with acute liver failure. Intensive Care Med. 2009;35:1390–6.CrossRefPubMed Karvellas CJ, Pink F, McPhail M, Cross T, Auzinger G, Bernal W, Sizer E, Kutsogiannis DJ, Eltringham I, Wendon JA. Predictors of bacteraemia and mortality in patients with acute liver failure. Intensive Care Med. 2009;35:1390–6.CrossRefPubMed
23.
go back to reference Bhatia V, Singhal A, Panda SK, Acharya SK. A 20-year single-center experience with acute liver failure during pregnancy: is the prognosis really worse? Hepatology. 2008;48:1577–85.CrossRefPubMed Bhatia V, Singhal A, Panda SK, Acharya SK. A 20-year single-center experience with acute liver failure during pregnancy: is the prognosis really worse? Hepatology. 2008;48:1577–85.CrossRefPubMed
24.
go back to reference Bose PD, Das BC, Kumar A, Gondal R, Kumar D, Kar P. High viral load and deregulation of the progesterone receptor signaling pathway: association with hepatitis E-related poor pregnancy outcome. J Hepatol. 2011;54:1107–13.CrossRefPubMed Bose PD, Das BC, Kumar A, Gondal R, Kumar D, Kar P. High viral load and deregulation of the progesterone receptor signaling pathway: association with hepatitis E-related poor pregnancy outcome. J Hepatol. 2011;54:1107–13.CrossRefPubMed
25.
go back to reference Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55:988–97.CrossRefPubMed Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55:988–97.CrossRefPubMed
26.
go back to reference Acharya SK, Panda SK. Hepatitis E: water, water everywhere – now a Global Disease. J Hepatology. 2011;54:9–11.CrossRef Acharya SK, Panda SK. Hepatitis E: water, water everywhere – now a Global Disease. J Hepatology. 2011;54:9–11.CrossRef
27.
go back to reference Devarbhavi H, Patil M, Reddy VV, et al. Drug-induced acute liver failure in children and adults: results of a single-centre study of128 patients. Liver Int. 2018;38:1322–9.CrossRefPubMed Devarbhavi H, Patil M, Reddy VV, et al. Drug-induced acute liver failure in children and adults: results of a single-centre study of128 patients. Liver Int. 2018;38:1322–9.CrossRefPubMed
29.
go back to reference Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of Liver (INASL) consensus paper on acute liver failure (Part-2): management of acute liver failure. J Clin Exp Hepatol. 2020;10:477–517.CrossRefPubMedPubMedCentral Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of Liver (INASL) consensus paper on acute liver failure (Part-2): management of acute liver failure. J Clin Exp Hepatol. 2020;10:477–517.CrossRefPubMedPubMedCentral
30.
31.
go back to reference Tan EXX, Wang MX, Pang J, Lee GH. Plasma exchange in patients with acute and acute on chronic liver failure. World J Gastrenterol. 2020;26:219–45.CrossRef Tan EXX, Wang MX, Pang J, Lee GH. Plasma exchange in patients with acute and acute on chronic liver failure. World J Gastrenterol. 2020;26:219–45.CrossRef
34.
go back to reference Shalimar, Sonika U, Kedia S, et al. Comparison of dynamic changes among various prognostic scores in viral hepatitis-related acute liver failure. Ann Hepatol. 2018;17:403–12.CrossRefPubMed Shalimar, Sonika U, Kedia S, et al. Comparison of dynamic changes among various prognostic scores in viral hepatitis-related acute liver failure. Ann Hepatol. 2018;17:403–12.CrossRefPubMed
35.
go back to reference Kumar R, Hanish Sharma S, Goyal R, et al. Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure. Gut. 2012;61:1068–75.CrossRefPubMed Kumar R, Hanish Sharma S, Goyal R, et al. Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure. Gut. 2012;61:1068–75.CrossRefPubMed
36.
go back to reference Donnelly MC, Hayes PC, Simpson KJ. The changing face of liver transplantation for acute liver failure: assessment of current status and implications for future practice. Liver Transplant. 2016;22:527–35.CrossRef Donnelly MC, Hayes PC, Simpson KJ. The changing face of liver transplantation for acute liver failure: assessment of current status and implications for future practice. Liver Transplant. 2016;22:527–35.CrossRef
37.
go back to reference Ikegami T, Taketomi A, Soejima Y, et al. Living donor liver transplantation for acute liver failure: a 10-year experience in a single center. J Am Coll Surg. 2008;206:412–8.CrossRefPubMed Ikegami T, Taketomi A, Soejima Y, et al. Living donor liver transplantation for acute liver failure: a 10-year experience in a single center. J Am Coll Surg. 2008;206:412–8.CrossRefPubMed
38.
go back to reference O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in acute liver failure liver. Gastroenterology. 1989;97:439–45.CrossRefPubMed O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in acute liver failure liver. Gastroenterology. 1989;97:439–45.CrossRefPubMed
39.
go back to reference Bernuau J, Goudeau A, Poynard T, et al. Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology. 1986;6:648–51.CrossRefPubMed Bernuau J, Goudeau A, Poynard T, et al. Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology. 1986;6:648–51.CrossRefPubMed
40.
go back to reference Lee HS, Choi GH, Joo DJ, et al. Prognostic value of model for end stage liver disease scores in patients with fulminant hepatic failure. Transplant Proc Elsevier Inc. 2013;45:2992–4.CrossRef Lee HS, Choi GH, Joo DJ, et al. Prognostic value of model for end stage liver disease scores in patients with fulminant hepatic failure. Transplant Proc Elsevier Inc. 2013;45:2992–4.CrossRef
41.
go back to reference Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl JMed. 2008;359:1018–26.CrossRef Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl JMed. 2008;359:1018–26.CrossRef
42.
go back to reference Dhiman RK, Jain S, Maheshwari U, et al. Early indicators of prognosis in fulminant hepatic failure: an assessment of the model for end-stage liver disease (MELD) and King’s College Hospital Criteria. Liver Transplant. 2007;13:814–21.CrossRef Dhiman RK, Jain S, Maheshwari U, et al. Early indicators of prognosis in fulminant hepatic failure: an assessment of the model for end-stage liver disease (MELD) and King’s College Hospital Criteria. Liver Transplant. 2007;13:814–21.CrossRef
Metadata
Title
Overview of acute liver failure in India
Author
Subrat Kumar Acharya
Publication date
09-05-2024
Publisher
Springer India
Published in
Indian Journal of Gastroenterology / Issue 2/2024
Print ISSN: 0254-8860
Electronic ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-024-01589-z

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