Current status of etiology and outcomes of acute liver failure in India-A multicentre study from tertiary centres.

IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY

Indian Journal of Gastroenterology Pub Date : 2024-08-07 DOI:10.1007/s12664-024-01634-x

Akash Roy, Karan Kumar, Madhumita Premkumar, Amarthya Sree, Anand Gupta, Mithun Sharma, Manasa Alla, Sowmya Iyengar, Shantan Venishetty, Uday C Ghoshal, Mahesh Goenka, Padaki Nagaraja Rao, Vivek Anand Saraswat, Nageshwar Duvvur Reddy, Anand V Kulkarni, Rajender K Reddy

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Abstract

Background and aims: Acute liver failure (ALF) is a medical emergency and liver transplantation (LT) may be required as definitive therapy. The etiology varies across geographical locations and is mostly viral dominant in India. We aimed at evaluating the spectrum, impact of interventions (plasma exchange [PLEx], continuous renal replacement therapy [CRRT]) and outcomes of ALF in India in recent times.

Methods: A multicentre retrospective study across four major tertiary care centres.

Results: As many as 183 ALF patients (median age, 23 years; females, 43.1%; model for end-stage liver disease [MELD], 32.7) from January 2021 to December 2023 were included. Nineteen per cent had infection and 40.4% of patients satisfied King's College criteria (KCC) at admission. Most common cause for ALF was hepatitis A virus (HAV) (44.2%) followed by rodenticide poisoning (10.3%). Approximately 35% of patients each received either PLEx or CRRT. The 7, 14 and 21-day transplant-free survival probability was 65.5%, 60.1%, and 57.3%, respectively. Only 3.8% of patients underwent liver transplantation. On multivariable Cox regression analysis, hemoglobin (HR, 0.74 [0.63-0.87]), lactate (HR, 1.14 [1.03-1.26]), advanced hepatic encephalopathy (HE) (HR, 4.87 [1.89-12.5]) and fulfilling KCC [HR, 10.04 [4.57-22.06]) at admission were the independent predictors of mortality. A model including KCC + lactate + HE ≥ 3 with or without hemoglobin had an AUROC of 0.81-0.84 to predict mortality. In those who underwent PLEx, advanced HE (HR, 4.13 [1.75-9.7]), procalcitonin (HR, 1.18 [1.07-1.30]) and KCC (HR, 4.6 [1.6-13.1), while for those who received CRRT, lactate (HR, 1.37 [1.22-1.54]) and KCC (HR, 6.4 [2.5-15.8]) independently predicted mortality.

Conclusions: Hepatitis A virus is currently the most common cause for ALF in India, emphasizing the need for universal vaccination programmes. Spontaneous survival in tertiary care centres is 57%. LT rates were low.

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印度急性肝衰竭的病因和结果现状--来自三级中心的多中心研究。

背景和目的：急性肝衰竭（ALF）是一种医疗急症，可能需要肝移植（LT）作为最终治疗手段。不同地区的病因各不相同，在印度主要以病毒为主。我们的目的是评估近期印度 ALF 的病谱、干预措施（血浆置换 [PLEx]、持续肾脏替代疗法 [CRRT]）的影响和结果：方法：在四个主要的三级医疗中心进行多中心回顾性研究：研究纳入了2021年1月至2023年12月期间的183名ALF患者（中位年龄23岁；女性占43.1%；终末期肝病模型[MELD]32.7）。19%的患者有感染，40.4%的患者入院时符合国王学院标准（KCC）。ALF最常见的病因是甲型肝炎病毒（HAV）（44.2%），其次是杀鼠剂中毒（10.3%）。约 35% 的患者分别接受了 PLEx 或 CRRT 治疗。7天、14天和21天无移植生存概率分别为65.5%、60.1%和57.3%。只有3.8%的患者接受了肝移植。在多变量考克斯回归分析中，入院时的血红蛋白（HR，0.74 [0.63-0.87]）、乳酸（HR，1.14 [1.03-1.26]）、晚期肝性脑病（HE）（HR，4.87 [1.89-12.5]）和KCC（HR，10.04 [4.57-22.06]）是预测死亡率的独立因素。KCC+乳酸+HE≥3（含或不含血红蛋白）模型预测死亡率的AUROC为0.81-0.84。在接受PLEx治疗的患者中，晚期HE（HR，4.13 [1.75-9.7]）、降钙素原（HR，1.18 [1.07-1.30]）和KCC（HR，4.6 [1.6-13.1]）可独立预测死亡率，而在接受CRRT治疗的患者中，乳酸盐（HR，1.37 [1.22-1.54]）和KCC（HR，6.4 [2.5-15.8]）可独立预测死亡率：结论：甲型肝炎病毒是印度目前最常见的ALF病因，因此需要普及疫苗接种计划。三级医疗中心的自发存活率为 57%。LT率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

3.90

自引率

10.00%

发文量

期刊介绍： The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.