Original Article

Digestive Diseases and Sciences

, Volume 57, Issue 3, pp 777-785

First online:

Short and Long-Term Outcomes in Patients with Acute Liver Failure Due to Ischemic Hepatitis

  • Ryan M. TaylorAffiliated withDepartment of Internal Medicine, University of Kansas
  • , Shannan TujiosAffiliated withDepartment of Internal Medicine, University of Michigan Medical School, University of Michigan Medical Center
  • , Kartik JinjuvadiaAffiliated withDepartment of Internal Medicine, University of Michigan Medical School, University of Michigan Medical Center
  • , Timothy DavernAffiliated withCalifornia Pacific Medical Center
  • , Obaid S. ShaikhAffiliated withUniversity of Pittsburgh Medical Center
  • , Steve HanAffiliated withUniversity of California Los Angeles
  • , Raymond T. ChungAffiliated withMassachusetts General Hospital
  • , William M. LeeAffiliated withUniversity of Texas Southwestern Medical Center
  • , Robert J. FontanaAffiliated withDepartment of Internal Medicine, University of Michigan Medical School, University of Michigan Medical Center Email author 

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Abstract

Aims

The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes.

Methods

Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis.

Results

Ischemic hepatitis accounted for 51 (4.4%) of the 1147 ALF patients enrolled. Mean age was 50 years, 63% were female, and only 31% had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69%. Three-week spontaneous survival was 71%, two patients (4%) underwent liver transplantation, and the remaining 13 patients (25%) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95% CI 1.1–1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95% CI 1.1–66.5, P = 0.04). Nineteen of the 28 short-term survivors (68%) were still alive at a median follow-up of 3.7 years whereas nine (32%) others had died at a median follow-up of 2 months.

Conclusions

A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.

Keywords

Liver transplantation Hypoxic hepatitis Aminotransferase levels Coagulopathy Encephalopathy