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Hepatology International

, Volume 7, Issue 2, pp 714–720 | Cite as

Changing etiology of liver failure in 3,916 patients from northern China: a 10-year survey

  • Shaoli You
  • Yihui Rong
  • Bing Zhu
  • Aimin Zhang
  • Hong Zang
  • Hongling Liu
  • Dongze Li
  • Zhihong WanEmail author
  • Shaojie XinEmail author
Original Article

Abstract

Purpose

To investigate the etiological characteristics of patients with liver failure in the past 10 years.

Methods

Clinical and investigational data in hospitalized patients with liver failure admitted from 2002 to 2011 were retrospectively analyzed. Standard definitions and criteria were used to assess disease etiology.

Results

Of these 3,916 patients, 3,429 (87.6 %) had acute-on-chronic liver failure (ACLF), 114 (2.9 %) acute liver failure (ALF), and 373 (9.5 %) subacute liver failure. Viral infection was the most common cause of liver failure in the 3,295 patients (84.1 %). Hepatitis of unknown etiology was deemed responsible for 371 cases of liver failure (9.5 %). Drug-induced liver injury, alcoholic hepatitis, and autoimmune hepatitis led to 120 cases (3.1 %), 109 cases (2.8 %), and 19 cases (0.5 %), respectively. The most common cause of ACLF was HBV infection (87.3 %), while the main causes of acute and subacute liver failure were hepatitis of unknown etiology (39.4 %), viral infection (36.6 %), and drug-induced liver injury (19.3 %). Our data showed that the incidence of liver failure caused by HBV gradually decreased from 86.5 % in 2002 to 69.2 % in 2011. However, the incidence of hepatitis of unknown etiology, drug-induced liver injury, and alcoholic hepatitis was increased.

Conclusions

HBV infection is the main cause of liver failure in China. However, the incidence of HBV-related liver failure has gradually decreased in the past 10 years. Hepatitis of unknown etiology has replaced HBV infection as the most common apparent cause of acute liver failure.

Keywords

Liver injury Liver failure Etiology Prognosis 

Notes

Conflict of interest

None to declare.

Financial support

This research was supported by grants from the 12th Five-Year National Science and Technology Major Project for Infectious Diseases (No. 2012ZX10002004-005) and 12th Five-Year Grand Project of PLA (No. BWS11J075).

References

  1. 1.
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association, Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology. Diagnostic and treatment guidelines for liver failure. Zhonghua Gan Zang Bing Za Zhi. 2006;14:643–646Google Scholar
  2. 2.
    Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute-on-chronic liver failure; consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Hepatol Int. 2009;3:269–282CrossRefGoogle Scholar
  3. 3.
    Williams R, Wendon J. Indications for orthotopic liver transplantation in fulminant liver failure. Hepatology. 1994;20:S5–S10CrossRefGoogle Scholar
  4. 4.
    Lee WM, Squires RH, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: summary of a workshop. Hepatology. 2008;47:1401–1415CrossRefGoogle Scholar
  5. 5.
    Areia M, Romaozinho JM, Ferreira M, Amaro P, Leitao MC. Fulminant hepatic failure: a Portuguese experience. Eur J Gastroenterol Hepatol. 2007;19:665–669CrossRefGoogle Scholar
  6. 6.
    Escorsell A, Mas A, de la Mata M. Acute liver failure in Spain: analysis of 267 cases. Liver Transpl. 2007;13:1389–1395CrossRefGoogle Scholar
  7. 7.
    Ke WM, Ye YN, Huang S. Discriminate function for prognostic indexes and probability of death in chronic severe hepatitis B. J Gastroenterol. 2003;38:861–864CrossRefGoogle Scholar
  8. 8.
    Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol. 2004;38:S158–S168CrossRefGoogle Scholar
  9. 9.
    Hiramatsu A, Takahashi S, Aikata H, Azakami T, Katamura Y, Kawaoka T, et al. Etiology and outcome of acute liver failure: retrospective analysis of 50 patients treated at a single center. J Gastroenterol Hepatol. 2008;23:1216–1222CrossRefGoogle Scholar
  10. 10.
    Ichai P, Samuel D. Etiology and prognosis of fulminant hepatitis in adults. Liver Transpl. 2008;14:S67–S79CrossRefGoogle Scholar
  11. 11.
    Huang K, Hu JH, Wang HF, He WP, Chen J, Duan XZ, et al. Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol. 2011;17:3448–3452CrossRefGoogle Scholar
  12. 12.
    Liu C, Wang YM, Fan K. Epidemiological and clinical features of hepatitis B virus related liver failure in China. World J Gastroenterol. 2011;17:3054–3059CrossRefGoogle Scholar
  13. 13.
    Dhiman RK, Seth AK, Jain S, Chawla YK, Dilawari JB. Prognostic evaluation of early indicators in fulminant hepatic failure by multivariate analysis. Dig Dis Sci. 1998;43:1311–1316CrossRefGoogle Scholar
  14. 14.
    Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947–954CrossRefGoogle Scholar
  15. 15.
    Chinese Society of Infectious Diseases and Parasitology, Chinese Society of Hepatology. Management scheme of diagnostic and therapeutic criteria of viral hepatitis. Zhonghua Gan Zang Bing Za Zhi. 2000;8:324–329Google Scholar
  16. 16.
    Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–938CrossRefGoogle Scholar
  17. 17.
    The Chinese National Workshop on Fatty Liver and Alcoholic Liver Disease for the Chinese Liver Disease Association. Guidelines for management of alcoholic liver disease-an updated and revised edition. Zhonghua Gan Zang Bing Za Zhi. 2010;18:163–166Google Scholar
  18. 18.
    Collaborative Group of Hepatobiliary Disease of Digestive Disease Branch of Chinese Medical Association. Recommendation of management for drug induced acute liver injury (Protocol). Chinese Journal of Digestion. 2007;27:765–767Google Scholar
  19. 19.
    Roberts EA, Schilsky ML. Diagnosis and treatment of Wilson disease: an update. Hepatology. 2008;47:2089–2111CrossRefGoogle Scholar
  20. 20.
    Smith ID, Simpson KJ, Garden OJ, Wigmore SJ. Nonparacetamol drug-induced fulminant hepatic failure among adults in Scotland. Eur J Gastroenterol Hepatol. 2005;17:161–167CrossRefGoogle Scholar
  21. 21.
    Miyake Y, Iwasaki Y, Makino Y, Kobashi H, Takaguchi K, Ando M, et al. Prognostic factors for fatal outcomes prior to receiving liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. J Gastroenterol Hepatol. 2007;22:855–861CrossRefGoogle Scholar
  22. 22.
    Furukawa M, Kasajima S, Nakamura Y. Toxic hepatitis induced by show-wu-pian, a Chinese herbal preparation. Intern Med. 2010;49:1537–1540CrossRefGoogle Scholar
  23. 23.
    Wang YP, Shi B, Chen YX, Xu J, Jiang CF, Xie WF. Drug-induced liver disease: an 8-year study of patients from one gastroenterological department. J Dig Dis. 2009;10:195–200CrossRefGoogle Scholar
  24. 24.
    Brandsaeter B, Hockerstedt K, Friman S, Ericzon BG, Kirkegaard P, Isoniemi H, et al. Fulminant hepatic failure: outcome after listing for highly urgent liver transplantation—12 years experience in the Nordic countries. Liver Transpl. 2002;8:1055–1062CrossRefGoogle Scholar
  25. 25.
    Oketani Makoto, Ido Akio, Tsubouchi Hirohito. Changing etiologies and outcomes of acute liver failure: a perspective from Japan. J Gastroenterol Hepatol. 2011;26:65–71CrossRefGoogle Scholar
  26. 26.
    Centers for Disease Control and Prevention (CDC). Progress in hepatitis B prevention through universal infant vaccination—China, 1997–2006. MMWR Morb Mortal Wkly Rep. 2007;56:441–445Google Scholar
  27. 27.
    Luo Z, Li L, Ruan B. Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period. Int J Infect Dis. 2012;16:e82–e88CrossRefGoogle Scholar
  28. 28.
    Hadem J, Stiefel P, Bahr MJ, Tillmann HL, Rifai K, Klempnauer J, et al. Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure. Clin Gastroenterol Hepatol. 2008;6:339–345CrossRefGoogle Scholar
  29. 29.
    Garg H, Kumar A, Garg V, Sharma P, Sharma BC, Sarin SK, et al. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Dig Liver Dis. 2012;44:166–171CrossRefGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2013

Authors and Affiliations

  • Shaoli You
    • 1
  • Yihui Rong
    • 1
  • Bing Zhu
    • 1
  • Aimin Zhang
    • 1
  • Hong Zang
    • 1
  • Hongling Liu
    • 1
  • Dongze Li
    • 1
  • Zhihong Wan
    • 1
    Email author
  • Shaojie Xin
    • 1
    Email author
  1. 1.Liver Failure Treatment and Research Center, Beijing 302 HospitalBeijingChina

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