OBJECTIVE: To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome. RESEARCH DESIGN AND METHODS: Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included. RESULTS: A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively. CONCLUSIONS: Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.
OBJECTIVE: To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome. RESEARCH DESIGN AND METHODS: Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included. RESULTS: A total of 279 patients were identified. The most common cause of ALF were acetaminophentoxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively. CONCLUSIONS:Acetaminophentoxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophenpatients without transplantation.
Authors: Mitchell R McGill; Matthew R Sharpe; C David Williams; Mohammad Taha; Steven C Curry; Hartmut Jaeschke Journal: J Clin Invest Date: 2012-03-01 Impact factor: 14.808
Authors: Ayako Suzuki; Raul J Andrade; Einar Bjornsson; M Isabel Lucena; William M Lee; Nancy A Yuen; Christine M Hunt; James W Freston Journal: Drug Saf Date: 2010-06-01 Impact factor: 5.606
Authors: Ali Canbay; Frank Tacke; Johannes Hadem; Christian Trautwein; Guido Gerken; Michael P Manns Journal: Dtsch Arztebl Int Date: 2011-10-21 Impact factor: 5.594
Authors: Darren G N Craig; Caroline M Bates; Janice S Davidson; Kirsty G Martin; Peter C Hayes; Kenneth J Simpson Journal: Br J Clin Pharmacol Date: 2012-02 Impact factor: 4.335
Authors: Nina Weiler; Andreas Schlotmann; Andreas Anton Schnitzbauer; Stefan Zeuzem; Martin-Walter Welker Journal: Dtsch Arztebl Int Date: 2020-01-24 Impact factor: 5.594
Authors: K Rajender Reddy; Caitlyn Ellerbe; Michael Schilsky; R Todd Stravitz; Robert J Fontana; Valerie Durkalski; William M Lee Journal: Liver Transpl Date: 2016-04 Impact factor: 5.799
Authors: Rachel J Church; Gerd A Kullak-Ublick; Jiri Aubrecht; Herbert L Bonkovsky; Naga Chalasani; Robert J Fontana; Jens C Goepfert; Frances Hackman; Nicholas M P King; Simon Kirby; Patrick Kirby; John Marcinak; Sif Ormarsdottir; Shelli J Schomaker; Ina Schuppe-Koistinen; Francis Wolenski; Nadir Arber; Michael Merz; John-Michael Sauer; Raul J Andrade; Florian van Bömmel; Thierry Poynard; Paul B Watkins Journal: Hepatology Date: 2018-06-27 Impact factor: 17.425
Authors: Darren G N Craig; Caroline M Bates; Janice S Davidson; Kirsty G Martin; Peter C Hayes; Kenneth J Simpson Journal: Br J Clin Pharmacol Date: 2011-02 Impact factor: 4.335