Acute liver failure. Experience with 145 patients.

Acute liver failure (ALF) is an uncommon but serious disease still carrying a high mortality. This report describes one of the largest series of cases of acute failure, managed on a simple intensive supportive therapeutic regimen. One hundred fifty-eight patients with ALF were admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences (AIIMS) during the period July 1976 to December 1981. Data from 145 were completed and analyzed for this report. Of the patients, 85.4% were below the age of 40 years. The female-to-male ratio was 1.3:1. Of the 77 women in the reproductive age group, 59.7% were pregnant. All cases of ALF were secondary to viral hepatitis. Cerebral edema, bleeding, infection, and renal failure were seen in 57.2, 57.2, 39.3, and 16.5% of patients, respectively. Overall survival was 28.9% of patients. It was 33% below the age of 40 years and only 4.8% above this age. Pregnancy did not adversely affect the prognosis. Survival was related to grade of coma, being 22.8% for patients in Grade IV coma and 62% for patients in Grade I coma. In fatal cases the immediate complications resulting in death were cerebral edema (63%), bleeding (30%), renal failure (10.6%), and infection (8.7%). Presence of HBsAg, a serum bilirubin of over 20 mg%, and serum sodium less that 119 mEq/liter were indicators of poor prognosis. A simple, intensive, support therapy yielded results comparable to those reported by centers using a variety of complex therapeutic regimens.