Acute liver failure: Clinical features, outcome analysis, and applicability of prognostic criteria

Acute liver failure (ALF) is an uncommon condition associated with high mor bidity and mortality. We performed a retrospective analysis of patients eva luated for ALE The aim of our study is to determine the clinical features a nd outcome of such patients and to assess the validity of King's College Ho spital (KCH) prognostic criteria, One hundred seventy-seven patients were e valuated for ALF during a period of 13 years. Mean age was 39 years, and 63 % were women. The causes included viral hepatitis (31%), acetaminophen toxi city (19%), idiosyncratic drug reactions (12%), miscellaneous causes (11%), and an indeterminate group (28%), Twenty-live patients (14%) recovered wit h medical therapy (group I), 65 patients (37%) died without orthotopic Live r transplantation (OLT; group II), and 87 patients (49%) underwent OLT (gro up III). patients in group II were older and often had advanced encephalopa thy, whereas those in group I had less hyperbilirubinemia and often had hyp eracute failure. KCH criteria had high specificity and positive predictive value but low negative predictive value for a poor outcome. We conclude tha t early prognostication is needed in patients with ALF to assist decision m aking regarding OLT. The fulfillment of KCH criteria usually predicts a poo r outcome, but a lack of fulfillment does not predict survival. Copyright ( C) 2000 by the American Association for the Study of liver Diseases.