Prognostic value of abdominal CT scanning and hepatic histopathology in patients with acute liver failure

Acute liver failure has extremely high mortality without liver transplantat ion. We attempted to determine the value of abdominal CT scanning and liver biopsy in its management. A retrospective analysis of patients with acute liver failure was performed; demographic, clinical, radiologic and histopat hologic features were noted. Over a period of 13 years, 177 patients were e valuated. The mean age was 39 years and 63% were females. The patients were divided into three groups. Fourteen percent survived with medical manageme nt (group I), 37% died (group II), and 49% had liver transplantation (group III). Most patients showed diffuse low density of the liver on CT scanning and the proportions were similar in the three groups. Moderate to large as cites was not present in group I but occurred in 31% of patients in group I I and in 15% in group III. Mean hepatic volumes were similar in the three g roups; however, 97% of the patients with a liver volume of less than 1000 m i either died or required liver transplantation. Liver biopsies among patie nts with spontaneous recovery (group I) were distinguished by the presence of regenerative changes and a hepatic parenchymal necrosis of less than 50% . These results suggest that in patients with acute liver failure a liver v olume of less than 1000 mi and/or hepatic parenchymal necrosis of greater t han 50% is indicative of a poor prognosis. This information may assist deci sion making in such patients, in particular, regarding the need for liver t ransplantation.