How to Define Acute Liver Failure Patients with Pre-Existing Liver Disease without Signs of Cirrhosis

GND
1117491080
ORCID
0000-0003-0950-9607
Affiliation
Department of Gastroenterology, Hepatology und Infectious Diseases, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
Gottlieb, Aline;
Affiliation
Department for Gastroenterology and Hepatology, Center for Internal Medicine, University Hospital, University Duisburg-Essen, Essen, Germany
Kottmann, Maren;
GND
1023555263
LSF
60123
Affiliation
Department for Gastroenterology and Hepatology, Center for Internal Medicine, University Hospital, University Duisburg-Essen, Essen, Germany
Manka, Paul;
GND
108127252X
Affiliation
Department for Gastroenterology and Hepatology, Center for Internal Medicine, University Hospital, University Duisburg-Essen, Essen, Germany
Bedreli, Sotiria;
GND
123531020
Affiliation
Department of Gastroenterology, Hepatology und Infectious Diseases, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
Hadem, Johannes;
GND
132951630
ORCID
0000-0003-3487-9810
Affiliation
Department of Gastroenterology, Hepatology und Infectious Diseases, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
Bechmann, Lars;
GND
1071577808
ORCID
0000-0003-2943-0015
Affiliation
Department of Gastroenterology, Hepatology und Infectious Diseases, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
Sowa, Jan-Peter;
GND
1071577948
Affiliation
Department for Gastroenterology and Hepatology, Center for Internal Medicine, University Hospital, University Duisburg-Essen, Essen, Germany
Gerken, Guido;
GND
122276493
ORCID
0000-0001-6069-7899
LSF
12758
Affiliation
Department of Gastroenterology, Hepatology und Infectious Diseases, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
Canbay, Ali E.

Background: The definition of acute liver failure (ALF) usually implies no previous liver injury. Though, some patients admitted to liver transplantation centers with the diagnosis of ALF are obese or have diabetes. Elevated liver enzymes were not recorded previously, and no signs of cirrhosis or prior decompensation of the liver function were ever present. Still, these patients differ from the “typical” ALF-patient.

Goals: In this study, we aimed to confirm acute-on-chronic-liver failure (AOCLF) in patients diagnosed with ALF and to identify possible differences between ALF and AOCLF.

Study: Patients were retrospectively recruited from all patients admitted to the University Hospital Essen with diagnosis of ALF between 2008 and 2015. Data of 163 patients were evaluated, resulting in a reclassification of 32 patients as AOCLF (remaining ALF: 131). Demographic and clinical data as well as serum parameters, including cell death markers, were correlated with clinical outcome.

Results: Patients with AOCLF were significantly older, had a higher body mass index (BMI), and were more often male. The cause for liver failure in these patients differed significantly from patients who had an actual ALF. Significant differences were also found for serum liver enzymes. Outcome of patients did not differ between AOCLF and ALF. Though, lower BMI and MELD and higher AST and GLDH were predictors for a beneficial outcome.

Conclusion: AOCLF is still commonly misdiagnosed as ALF. While clinical outcome does not significantly differ between ALF and AOCLF, risk factors for adverse outcome may significantly differ between these entities.

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Citation style:
Gottlieb, A., Kottmann, M., Manka, P., Bedreli, S., Hadem, J., Bechmann, L., Sowa, J.-P., Gerken, G., Canbay, A., 2018. How to Define Acute Liver Failure Patients with Pre-Existing Liver Disease without Signs of Cirrhosis. https://doi.org/10.1159/000492869
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