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Acute Liver Failure

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E B Haagsma – One of the best experts on this subject based on the ideXlab platform.

  • Acute Liver Failure: spontaneous recovery or transplantation?
    Scandinavian journal of gastroenterology. Supplement, 1997
    Co-Authors: L Meerman, J G Zijlstra, J J Schweizer, R Verwer, M J Slooff, E B Haagsma
    Abstract:

    Decision-making in Acute Liver Failure. Acute Liver Failure is a disease with multiple organ involvement and a high mortality rate. Conservative management alone will only partly influence the outcome. The option of emergency Liver transplantation has greatly improved survival rates, but unables spontaneous recovery. A set of prognostic criteria enables selection of patients who will benefit the most from emergency Liver transplantation. Retrospective review and survey of the Groningen results. Of 52 patients (33 adults and 19 children) admitted for Acute Liver Failure 2 were beyond recovery and died, 9 were treated conservatively and recovered and 41 were listed for emergency Liver transplantation because of an estimated survival rate < 20%. Of these, 3 died and 1 recovered spontaneously while waiting and 37 were transplanted. Survival rate for 41 patients listed for transplantation was 23 (56%) and was similar for children and adults. In patients with Acute Liver Failure, management and decision-making in a specialized Liver unit with the possibility of emergency Liver transplantation is mandatory.

  • Acute Liver Failure: Spontaneous recovery or transplantation?
    Scandinavian Journal of Gastroenterology, 1997
    Co-Authors: L Meerman, J G Zijlstra, J J Schweizer, R Verwer, M J Slooff, E B Haagsma
    Abstract:

    Background: Decision-making in Acute Liver Failure. Acute Liver Failure is a disease with multiple organ involvement and a high mortality rate. Conservative management alone will only partly influence the outcome. The option of emergency Liver transplantation has greatly improved survival rates, but unables spontaneous recovery. A set of prognostic criteria enables selection of patients who will benefit the most from emergency Liver transplantation. Methods: Retrospective review and survey of the Groningen results. Results: Of 52 patients (33 adults and 19 children) admitted for Acute Liver Failure 2 were beyond recovery and died, 9 were treated conservatively and recovered and 41 were listed for emergency Liver transplantation because of an estimated survival rate

William M. Lee – One of the best experts on this subject based on the ideXlab platform.

  • drug induced Acute Liver Failure
    Clinics in Liver Disease, 2013
    Co-Authors: William M. Lee
    Abstract:

    Although Acute Liver Failure caused by drug-induced Liver injury comprises a small fraction of overall drug-induced Liver injury, these patients require high resource use and have relatively poor outcomes. Drug-induced Liver injury caused by idiosyncrasy more often leads to death or transplantation than does acetaminophen Acute Liver Failure, but the number of patients in each category receiving a graft is roughly the same. Efforts in the future to improve outcomes should focus on more effective treatments and better methods to identify those that might experience poor outcomes.

  • Elevated troponin I levels in Acute Liver Failure: is myocardial injury an integral part of Acute Liver Failure?
    Hepatology (Baltimore Md.), 2007
    Co-Authors: Nimisha K. Parekh, William M. Lee, Linda S. Hynan, James A. De Lemos, Julie Polson, Carla Pezzia, Ezmina Lalani, Joan S. Reisch, Anne M. Larson
    Abstract:

    Although rare instances of cardiac injury or arrhythmias have been reported in Acute Liver Failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and Acute stroke without underlying Acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in Acute Liver Failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of >1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic comacoma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). Conclusion: In Acute Liver Failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of Acute Liver Failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with Acute Liver Failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome. (HEPATOLOGY 2007;45:1489–1495.)

  • Detection of acetaminophen protein adducts in children with Acute Liver Failure of indeterminate cause.
    Pediatrics, 2006
    Co-Authors: Laura P. James, Timothy J. Davern, William M. Lee, Linda S. Hynan, Estella M. Alonso, Robert H. Squires, Jack A. Hinson, Norberto Rodriguez-baez, Karen F. Murray, Ross W. Shepherd
    Abstract:

    OBJECTIVE. Acetaminophen cysteine protein adducts are a widely recognized correlate of acetaminophen-mediated hepatic injury in laboratory animals. The objective of this study was to use a new assay for the detection of acetaminophen cysteine protein adducts in children with Acute Liver Failure to determine the role of acetaminophen toxicity in Acute Liver Failure of unknown cause. METHODS. Serum samples from children with Acute Liver Failure were measured for acetaminophen cysteine protein adducts using high-performance liquid chrochromatography with electrochemical detection. For comparison, samples from children with well-characterized acetaminophen toxicity and children with known other causes of Acute Liver Failure also were measured for acetaminophen cysteine protein adducts. The analytical laboratory was blinded to patient diagnoses. RESULTS. Acetaminophen cysteine protein adduct was detected in 90% of samples from children with Acute Liver Failure that was attributed to acetaminophen toxicity, 12.5% of samples from children with Acute Liver Failure of indeterminate cause, and 9.6% of samples from children with Acute Liver Failure that was attributed to other causes. Adduct-positive patients from the indeterminate cause subgroup had higher levels of serum aspartate aminotransferase and alanine aminaminotransferase and lower levels of bilirubin. Adduct-positive patients also had lower rates of transplantation and higher rates of spontaneous remission. CONCLUSIONS. A small but significant percentage of children with Acute Liver Failure of indeterminate cause tested positive for acetaminophen cysteine protein adducts, strongly suggesting acetaminophen toxicity as the cause of Acute Liver Failure. An assay for the detection of acetaminophen cysteine protein adducts can aid the diagnosis of acetaminophen-related Liver injury in children.

Xingpeng Wang – One of the best experts on this subject based on the ideXlab platform.

William Bernal – One of the best experts on this subject based on the ideXlab platform.

Robert H. Squires – One of the best experts on this subject based on the ideXlab platform.

  • Acetaminophen Adducts Detected in Serum of Pediatric Patients With Acute Liver Failure.
    Journal of pediatric gastroenterology and nutrition, 2015
    Co-Authors: Estella M. Alonso, Laura P. James, Song Zhang, Robert H. Squires
    Abstract:

    Objectives Previous studies in patients with Acute Liver Failure identified acetaminophen (APAP) protein adducts in the serum of 12% and 19% of children and adults, respectively, with Acute Liver Failure of indeterminate etiology. This report details APAP adducts testing in a subset (n=393) of patients with varied diagnoses in the Pediatric Acute Liver Failure Study Group (PALFSG).

  • Detection of acetaminophen protein adducts in children with Acute Liver Failure of indeterminate cause.
    Pediatrics, 2006
    Co-Authors: Laura P. James, Timothy J. Davern, William M. Lee, Linda S. Hynan, Estella M. Alonso, Robert H. Squires, Jack A. Hinson, Norberto Rodriguez-baez, Karen F. Murray, Ross W. Shepherd
    Abstract:

    OBJECTIVE. Acetaminophen cysteine protein adducts are a widely recognized correlate of acetaminophen-mediated hepatic injury in laboratory animals. The objective of this study was to use a new assay for the detection of acetaminophen cysteine protein adducts in children with Acute Liver Failure to determine the role of acetaminophen toxicity in Acute Liver Failure of unknown cause. METHODS. Serum samples from children with Acute Liver Failure were measured for acetaminophen cysteine protein adducts using high-performance liquid chromatography with electrochemical detection. For comparison, samples from children with well-characterized acetaminophen toxicity and children with known other causes of Acute Liver Failure also were measured for acetaminophen cysteine protein adducts. The analytical laboratory was blinded to patient diagnoses. RESULTS. Acetaminophen cysteine protein adduct was detected in 90% of samples from children with Acute Liver Failure that was attributed to acetaminophen toxicity, 12.5% of samples from children with Acute Liver Failure of indeterminate cause, and 9.6% of samples from children with Acute Liver Failure that was attributed to other causes. Adduct-positive patients from the indeterminate cause subgroup had higher levels of serum aspartate aminotransferase and alanine aminotransferase and lower levels of bilirubin. Adduct-positive patients also had lower rates of transplantation and higher rates of spontaneous remission. CONCLUSIONS. A small but significant percentage of children with Acute Liver Failure of indeterminate cause tested positive for acetaminophen cysteine protein adducts, strongly suggesting acetaminophen toxicity as the cause of Acute Liver Failure. An assay for the detection of acetaminophen cysteine protein adducts can aid the diagnosis of acetaminophen-related Liver injury in children.

  • Acute Liver Failure in Children
    Clinics in liver disease, 2006
    Co-Authors: John C. Bucuvalas, Nada Yazigi, Robert H. Squires
    Abstract:

    Acute Liver Failure (ALF) is a rare but devastating illness. Specific therapy to promote Liver recovery is often not available, and the underlying cause of the Liver Failure is often unknown. This article examines current knowledge of the epidemiology, pathobiology, and treatment of ALF in children and identifies potential gaps in this knowledge for future study.