Digestive Diseases and Sciences

, Volume 57, Issue 3, pp 777–785 | Cite as

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

  • Ryan M. Taylor
  • Shannan Tujios
  • Kartik Jinjuvadia
  • Timothy Davern
  • Obaid S. Shaikh
  • Steve Han
  • Raymond T. Chung
  • William M. Lee
  • Robert J. Fontana
Original Article

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 

Abbreviations

ALF

Acute liver failure

ALFSG

Acute Liver failure study Group

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

CHF

Congestive heart failure

INR

International normalized ratio

MI

Myocardial infarction

Notes

Acknowledgments

We gratefully acknowledge the support provided by the members of The Acute Liver Failure Study Group 1998–2008. This study was funded by NIH grant DK U-01 58369 for the Acute Liver Failure Study Group provided by the National Institute of Diabetes, Digestive, and Kidney Disease. Additional funding was provided by the Tips Fund of the Northwestern Medical Foundation and the Jeanne Roberts and Rollin and Mary Ella King Funds of the Southwestern Medical Foundation, and T-32 DK007745-12 to DD.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Ryan M. Taylor
    • 1
  • Shannan Tujios
    • 2
  • Kartik Jinjuvadia
    • 2
  • Timothy Davern
    • 3
  • Obaid S. Shaikh
    • 4
  • Steve Han
    • 5
  • Raymond T. Chung
    • 6
  • William M. Lee
    • 7
  • Robert J. Fontana
    • 2
  1. 1.Department of Internal MedicineUniversity of KansasKansas CityUSA
  2. 2.Department of Internal Medicine, University of Michigan Medical SchoolUniversity of Michigan Medical CenterAnn ArborUSA
  3. 3.California Pacific Medical CenterSan FranciscoUSA
  4. 4.University of Pittsburgh Medical CenterPittsburghUSA
  5. 5.University of California Los AngelesLos AngelesUSA
  6. 6.Massachusetts General HospitalBostonUSA
  7. 7.University of Texas Southwestern Medical CenterDallasUSA

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