Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure.
ACLF, Acute on Chronic liver Failure
AKI, Acute kidney injury
ALF, Acute Liver Failure
ALFED score
ALT, alanine transaminase
AST, aspartate transaminase
CNS, central nervous system
CT, Computerized tomography
HELLP, Hemolysis, elevated liver enzymes, and low platelets
ICH, Intracrainial hypertension
ICP, Intracrainial Pressure
ICU, Intensive care unit
INR, International normalised ratio
LAD, Liver assist device
LDLT, Living donor liver transplantation
LT, Liver transplantation
MAP, Mean arterial pressure
MELD, model for end-stage liver disease
MLD, Metabolic liver disease
NAC, N-acetyl cysteine
PALF, Pediatric ALF
WD, Wilson's Disease
acute liver failure
artificial liver support
liver transplantation
plasmapheresis
Journal
Journal of clinical and experimental hepatology
ISSN: 0973-6883
Titre abrégé: J Clin Exp Hepatol
Pays: India
ID NLM: 101574137
Informations de publication
Date de publication:
Historique:
received:
22
01
2020
accepted:
12
04
2020
entrez:
8
10
2020
pubmed:
9
10
2020
medline:
9
10
2020
Statut:
ppublish
Résumé
Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug-induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors.
Identifiants
pubmed: 33029057
doi: 10.1016/j.jceh.2020.04.011
pii: S0973-6883(20)30052-9
pmc: PMC7527855
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
477-517Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Dr Subrat K Acharya Has nothing to declare. This consensus statement was written by the members of the Task Force on Acute Liver failure (INASL-ALF Task Force), convened by Indian National Association for the Study of the Liver (INASL), India and was also supported by INASL, India.
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