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Survival rates increase for patients with acute liver failure

Both overall survival and transplant-free survival rates increased significantly in adults with acute liver failure, according to data published in the Annals of Internal Medicine.

Adrian Reuben, MBBS, division of gastroenterology and hepatology, Medical University of South Carolina, and colleagues also reported that characteristics and severity of acute liver failure (ALF) did not change significantly.

"Patients with ALF often deteriorate rapidly and therefore receive the most urgent ranking (status 1) in the United Network for Organ Sharing transplantation system," they wrote. "Treatment of ALF in the intensive care unit is largely supportive and includes ventilator and vasopressor support for respiratory and/or circulatory failure, renal replacement, plasma and blood transfusions, antibiotics, and measures to decrease intracranial pressure. N-acetylcysteine is used to treat [acetaminophen] overdose and has also shown efficacy in patients with ALF not due to [acetaminophen] toxicity, particularly those referred early and having only mild [hepatic encephalopathy]. However, few disease-specific or general treatments are available that yield improved outcomes."

The researchers updated data from 2002 that were published by the Acute Liver Failure Study Group (ALFSG).

They conducted an observational cohort study of 2,070 consecutively enrolled patients with ALF at 31 transplant centers in the United States over two 8-year periods: 1998 to 2005 and 2006 to 2013.

Results showed that 21-day survival rates increased between the two time periods in terms of overall survival (67.1% to 75.3%; P < .01), transplant-free survival (45.1% to 56.2%; P < .01) and posttransplantation survival (88.3% to 96.3%; P < .01). In addition, the researchers reported decreases in the use of vasopressors (34.9% to 27.8%), mechanical ventilation (65.7% to 56.1%), plasma infusions (65.2% to 47.1%) and blood infusions (44.3% to 27.6%) and increases in the use of N-acetylcysteine overall (48.9% to 69.3%) and in patients not due to acetaminophen toxicity (15.8% to 49.4%; P < .001).

Reuben and colleagues found that disease severity, overall clinical characteristics and cause distribution were similar in both periods.

"ALF, which affects only 2,000 patients annually in the United States, seemed stable with respect to causes, demographic characteristics, and severity over 16 years of study by the U.S. ALFSG," Reuben and colleagues wrote. "Nevertheless, ALF outcomes improved considerably over time, in association with slightly improved survival after liver transplantation and especially with improved survival without transplantation, which we speculate relates mainly to more effective intensive care unit management. The potentially beneficial role of N-acetylcysteine and more judicious use of ventilator support, vasopressors, and blood products should be further evaluated in future studies." – by Chelsea Frajerman Pardes

Disclosures: Reuben reports grants from the National Institutes of Health during the conduct of the study. Please see the full study for a complete list of all other authors' relevant financial disclosures.