Acute liver failure (ALF) in a specialist intensive care unit: a 7 year experience

Objective

To define the workload of a liver intensive care unit with respect to aetiology and outcome, including transplantation in patients with ALF.

Design

A retrospective analysis of 989 patients admitted consecutively with severe hepatic dysfunction, over a 7 year period.

Results

Aetiology of acute liver failure presented as patient episodes.

The spectrum of disease presenting as ALF has remained largely unchanged except for the recent identification of patients with haemophagocytic lymphohistiocytosis (11 cases since 1993). Overall survival has improved from 50/86 (58%) in 1991 to 101/149 (68%) in 1997. Over this time period the number of patients undergoing liver transplantation has increased from 11 in 1991 to 18 in 1997 (to November) and ITU survival in this group has remained stable at 82% and 78% respectively.

Conclusion

Improvements in the medical management of ALF and the identification of suitable candidates for liver transplantation have resulted in an increased survival. The prompt recognition and referral of patients with severe hepatic necrosis to centres offering transplantation may result in further improvements in survival

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