King's College criteria and the Clichy-Villejuif criteria require adjustments for assessing acute liver failure due to yellow fever.

Abstract

Background: Acute liver failure (ALF) is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease. Liver transplantation (LT) is the most impactful treatment. Yellow fever (YF) is an infectious disease that primarily affects the liver and has a high mortality rate. However, LT can be a viable option for treating rare cases with extensive liver involvement. However, the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.

Aim: To present necessary adjustments to established scoring systems for ALF secondary to YF.

Methods: This was an observational, retrospective, single-center study. Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil. During hospitalization, general supportive therapeutic measures were implemented, and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure. LT is considered a viable measure for patients with signs of end-stage liver failure.

Results: Eight of 14 (57%) patients developed severe neurological alterations within the first 96 hours after hospital admission. Four patients underwent emergency LT, and despite a moderate viral infection of the graft after transplantation, the 5-year survival rate was 50%. Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF, they are insufficient for predicting the risk of mortality in this context, primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.

Conclusion: To ensure good applicability in cases of YF-induced ALF, the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.