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Survival rates way up for adults with acute liver failure

Study suggests improved response to acetaminophen overdose is improving survival

Survival rates for patients with acute liver failure have increased significantly over the past 16 years, according to a study published in Annals of Internal Medicine.

The effects of specific changes in intensive care practice may be contributing to patients living longer. 

The Acute Liver Failure Study Group created the update to the U.S. experience with liver failure by collecting data on acute liver failure patients at 31 academic liver transplant centers across the U.S., including the University of Michigan Health System.

Researchers compared more than 2,000 patients with acute liver failure -- those hospitalized between 1998 and 2005 to those hospitalized with ALF between 2006 and 2013. They assessed survivorship in each group after 21 days of being hospitalized and found:

  • Overall survival rates rose from 67 to 75 percent;
  • Survival of ALF patients who did not receive a liver transplant rose from 45 percent to 56 percent;
  • Survival of ALF patients who were transplanted rose from 88 to 96 percent

“These trends show that if you manage this disease carefully, which sometimes means less rather than more intervention, you see better outcomes,” lead study author William Lee, M.D., a liver disease specialist at U-T Southwestern Medical Center says in a UTSW news release. “ALF is a rare condition – only 2,000 cases occur a year – but the disease is noteworthy because it typically happens in young people and treatment requires a large amount of resources.”

Acute liver failure involves sudden injury to the liver – most often from overdose of acetaminophen – that requires rapid hospitalization with an individual appearing healthy one day and requiring intensive care the next.

ALF results in brain dysfunction (hepatic encephalopathy) and clotting issues (coagulopathy), and ALF patients are given the most urgent ranking status for liver transplantation because of their rapidly deteriorating condition.

Researchers compared about 1,000 patients in each group and found that the causes of acute liver failure, the severity of the disease, and its characteristics remained relatively stable between the two time frames.

In both patient sets, acetaminophen overdose was the most common cause of ALF, accounting for nearly half of all cases. Accidental overdose - patients taking products containing acetaminophen for pain or fever over a period of time - was the most common cause throughout the study.

Other causes of ALF include pregnancy-associated liver injury, infection with hepatitis A or B viruses, Budd–Chiari syndrome, and Wilson disease.

Age, sex, and race characteristics of ALF patients also remained similar between the two time periods, researchers found, with women and Caucasians most affected and the mean age around 40. 

Despite similar causes and severity of acute liver failure, data shows outcomes have improved considerably, with slightly improved survival after liver transplantation and especially with improved survival without transplantation. The authors suggest that more effective intensive care unit management could be a contributing factor.

Researchers also noticed differences in therapeutic interventions.

Dr. Robert J. Fontana
Dr. Robert J. Fontana

There was more use of N-acetylcysteine, which is prescribed to treat acetaminophen overdose, for patients between 2006 and 2013, including many patients whose condition was not caused by acetaminophen.

There was less use of ventilator support, vasopressors, and plasma and red blood cell transfusions for patients between this time frame as well.

“In addition to less use of blood products and mechanical ventilation the increased use of N-acetylcysteine in patients with non-acetaminophen related liver failure may have also contributed to the improvements in overall outcomes,” says study co-author Robert J. Fontana, M.D., liver disease specialist in the University of Michigan Hepatology Program and contributor to the Acute Liver Failure Study Group since its inception.

“These data provide impetus for us to test other novel medical treatments to help patients with sudden onset liver failure," Fontana says.

The study was supported by funding from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and conducted by the Acute Liver Failure Study Group, which was founded at UT Southwestern in 1997.

Content provided by UT Southwestern

 

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