Acute Liver Failure: Current Evidence-Based Management for ICU Care

Abstract

Acute liver failure (ALF) is a rare and potentially life-threatening condition; the mortality rate for ALF remains high because of the rapid progression of the syndrome. A large number of etiologies such as drugs (acetaminophen being most common), viruses (hepatitis A and B), and autoimmune and metabolic causes can lead to ALF, but in a significant percentage of cases no exact etiology is determined. As the disease progresses to the life- threatening stage, management of these critically ill patients requires meticulous attention to their hemodynamic and neurologic condition and to other complications that can arise. This review describes the typical presentation of ALF and discusses its diagnosis and etiologies. The laboratory and radiologic hallmarks of the diagnosis are also described. The authors also evaluate the evidence for a variety of therapeutic maneuvers that have been put forward to ameliorate the course of ALF. Ultimately, given its often inexorable course, orthotopic liver transplant may bec...