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  • Open Access

Acute liver failure: a European perspective

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Critical Care201014 (Suppl 1) :P541

  • Published:


  • Acetaminophen
  • Critical Care
  • Renal Replacement Therapy
  • Chronic Liver Disease
  • Hepatic Encephalopathy


Acute liver failure (ALF) is a rare disease with a spectrum of presentations from mild coagulopathy and altered conscious level to multiple organ failure and intracranial hypertension (ICH). A new group, Acute Liver Failure studies in Europe (ALSiE), has and wishes to further initiate collaboration between centres with clinical expertise in the management of ALF. It aims to establish a pan-European database of clinical and demographic data in ALF and initiate clinical studies.


We describe the experience of 13 centres in seven countries over a 3-month period to 31 March 2009. ALF was defined as an INR >1.5 and encephalopathy in the absence of chronic liver disease. Results are presented as median and IQ range.


Eighty-five patients were treated, acetaminophen was the dominant aetiology in the UK, 60%, and represented 34% in other centres. At presentation INR was 3.8 (2.1 to 6.5), hepatic encephalopathy (HE) grade I (0 to 2) was observed and 20% required pressors. Grade III/IV coma was seen in 64% during their course and of these 25% developed ICH. Seventy-one per cent required ventilation, 58% renal replacement therapy and pressors in 65%. Ninety per cent required management in a critical care environment. Overall survival was 75% - 42 cases fulfilled poor prognostic criteria (PPC), of whom 31 were transplanted, 28 (90%) surviving to hospital discharge. Of the 11 remaining, four survived and seven died. Thirty-two out of 43 who did not fulfill PPC survived. Patients who died were older and had a predominant aetiology of hypoxic hepatitis. One organ support or less was associated with 70% survival with medical management alone. Two organ support or more was required in 55 patients and 27% survived with medical management, the remainder requiring transplantation or died.


ALF has a high prevalence of progression to multiple organ failure requiring a multidisciplinary approach (critical care, transplant surgery and hepatology) to achieve optimal outcome. The development of ICH is 25% in grade III/IV HE. Despite this, outcomes are good.

Authors’ Affiliations

King's College Hospital, London, UK
St Luc University Hospital, Brussels, Belgium
St James Hospital, Leeds, UK
University of Newcastle, UK
University of Birmingham, UK
Royal Free Hospital, London, UK
University of Barcelona, Spain
Hebrew University Hadassah Hospital, Jerusalem, Israel
Royal Infirmary Hospital, Edinburgh, UK
University of Hannover, Germany
Rigshospital, Copenhagen, Denmark


© BioMed Central Ltd. 2010