Materiały źródłowe

• #1 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  Acute liver failure (ALF) is a rare condition characterized by the abrupt onset of severe liver injury, manifest as a profound liver dysfunction as well as a confusional state called hepatic encephalopathy in individuals with no prior history of liver disease. The lack of prior liver disease is critical to the definition of ALF. […] Despite its relative rarity, ALF is important because it is associated with a high mortality. However, the dismal prognosis associated with ALF appears to be improving, at least in the West. This trend likely reflects the introduction of liver transplantation as a highly effective therapy, improvement in medical intensive care, and a change in the epidemiology of ALF with a shift from causes with a relatively poor prognosis (e.g., hepatitis B) to those with a relatively good prognosis (e.g. acetaminophen overdose).

• #2 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure (ALF) is a rare and often heterogeneous presentation of severe liver dysfunction in a patient with otherwise no pre-existing liver disease. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries. […] A recent review of the epidemiology of ALF over the past 50 years reveals the relative incidence of ALF secondary to hepatitis A and B to have declined, while that of acetaminophen to have increased, mainly in the United States and Western Europe.

• #3 Acute liver failure | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-liver-failure?lang=us

  Acute liver failure is rare, with 1 case per 100,000 in the developed world. […] Mortality is high in acute liver failure at ~50% (range 30-70%) with orthotopic liver transplant considered the definitive treatment. […] The goals of management include identification of reversible causes of acute liver failure, provide organ support to maximize the probability of recovery as well as to perform risk stratification and identify patients for consideration of early liver transplantation, as they may not survive supportive care.

• #4 A guide to managing acute liver failure | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/6/453

  Nearly 2,000 cases of acute liver failure occur each year in the United States. […] It is more common in women than in men, and more common in white people than in other races. The peak incidence is at a fairly young age, ie, 35 to 45 years. […] The most common cause of acute liver failure in the United States and other Western countries is acetaminophen toxicity, followed by viral hepatitis. […] There are a number of prognostic scores for acute liver failure, but each has limitations. […] Many patients with acute liver failure ultimately require orthotopic liver transplant, especially if they present with severe encephalopathy. […] Patients who present to a center that does not have the facilities for liver transplant should be transferred to a transplant center as soon as possible, preferably by air.

• #5 The Epidemiology of Acute Liver Failure (24.01.2020)

  https://di.aerzteblatt.de/int/archive/article/212054

  Acute liver failure (ALF) is a life-threatening event associated with high mortality. Currently, only estimates are available for its incidence. The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the largest statutory health insurance company, which represents 26.5 million people. […] The calculated incidence of ALF was 1.13/100 000 person-years, representing 4652 cases. […] The incidence of ALF was higher than previously estimated for Germany, with only a very low rate of LT despite high mortality. […] Since there are no national registries, the true incidence is unknown. Currently, only estimates based on cohort studies are available, while population-based data are rare. […] In total, 4652 cases of ALF were identified in the period from 1 January 2014 to 31 December 2018, resulting in a mean incidence of 1.13 per 100 000 person-years.

• #6 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #7 Acute Liver Failure | Cleveland Clinic

  https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/acute-liver-failure

  Acute liver failure is a rare clinical syndrome with an annual incidence of less than 10 cases per million population in the developed world. In the United States, approximately 2,000 cases of ALF are diagnosed each year. […] Geographically, ALF is more common in developing countries due to the higher incidence of infectious hepatitis in these regions.

• #8 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. […] ALF is considered a relatively rare disease, with an annual incidence of 2,000 to 3,000 cases per year. It accounts for 4 to 5% of all liver transplants. […] The course of the disease is variable and unpredictable. The mortality rate is 25 to 30% and the main causes of death are sepsis and cerebral edema. […] The probability of spontaneous recovery or transplant-free survival (TFS) is related to etiology and HE grade. […] The annual reported incidence is from 2,000 to 3,000 cases in the United States. […] In developed countries, paracetamol poisoning predominates in 45 to 55% of cases, with an incidence of 5.5 to 6.2 cases per million per year.

• #9 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  The incidence of ALF is poorly defined but estimated to be approximately 2,000 cases per year in the United States, making it far less common than chronic liver disease. […] There are significant geographical differences in the relative frequency of different causes of ALF across the world. […] The Acute Liver Failure Study Group consists of investigators and coordinators from 23 academic medical centers, all of which perform liver transplants, that receive support from the National Institute of Diabetes, Digestive, and Kidney Diseases to study the epidemiology, outcome and pathogenesis of ALF in the US.

• #10 The Epidemiology of Acute Liver Failure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7036472/

  Acute liver failure (ALF) is a life-threatening event associated with high mortality. Currently, only estimates are available for its incidence. The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the largest statutory health insurance company, which represents 26.5 million people. […] The calculated incidence of ALF was 1.13/100 000 person-years, representing 4652 cases. […] The incidence of ALF was higher than previously estimated for Germany, with only a very low rate of LT despite high mortality. […] The Federal Association of the AOK (Allgemeine Ortskrankenkasse) is the largest German health insurance organization with about 26.5 million insured individuals in 2018. […] In total, 4652 cases of ALF were identified in the period from 1 January 2014 to 31 December 2018, resulting in a mean incidence of 1.13 per 100 000 person-years.

• #11

  https://journals.lww.com/ajg/fulltext/2007/11000/population_based_surveillance_for_acute_liver.19.aspx

  Most U.S. studies of acute liver failure (ALF) patients have been conducted at tertiary care liver transplantation centers. The aim of this study was to conduct population-based surveillance for ALF. […] We conducted population-based surveillance for ALF within the 8 counties comprising Metropolitan Atlanta between November 2000 and October 2004. […] A total of 65 cases were enrolled, yielding an annualized incidence for all causes of ALF of 5.5 (95% CI 4.37.0) per million. […] Our population-based study suggests approximately 1,600 ALF cases occur in the United States each year.

• #12 Population-Based Surveillance for Acute Liver Failure. | EBSCOhost

  https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=00029270&AN=27173887&h=owHrwdtGUBuIODeu69W4nrE3GhvSYB4R2Hwta%2B31%2F7fgdO%2B6ae2KkKdu2%2FWsPJMTP4KLbG8jvfUHTjkgq1KWNw%3D%3D&crl=f

  Population-Based Surveillance for Acute Liver Failure. […] Most U.S. studies of acute liver failure (ALF) patients have been conducted at tertiary care liver transplantation centers. […] The aim of this study was to conduct population-based surveillance for ALF. […] We conducted population-based surveillance for ALF within the 8 counties comprising Metropolitan Atlanta between November 2000 and October 2004. […] A total of 65 cases were enrolled, yielding an annualized incidence for all causes of ALF of 5.5 (95% CI 4.3–7.0) per million. […] Our population-based study suggests approximately 1,600 ALF cases occur in the United States each year. […] Consistent with findings from studies conducted exclusively at liver transplantation centers, APAP-related ALF was the most common etiology. […] Increased awareness of APAP-related ALF in the medical community may limit future cases. […] More research is warranted into ALF of undetermined etiology, especially in children.

• #13 Acute Liver Failure | Cleveland Clinic

  https://my.clevelandclinic.org/departments/digestive/medical-professionals/hepatology/acute-liver-failure

  Acute liver failure is a rare clinical syndrome with an annual incidence of less than 10 cases per million population in the developed world. In the United States, approximately 2,000 cases of ALF are diagnosed each year. […] Geographically, ALF is more common in developing countries due to the higher incidence of infectious hepatitis in these regions.

• #14 Increased mortality from acute liver failure in Mexico | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-increased-mortality-from-acute-liver-S1665268119310324

  From 1998 to 2009, 2,193 ALF-related deaths were reported. […] A threefold increase in ALF mortality was observed during the period from 1998 to 2009 (the global mortality rate increased from 13.1 to 40.2 deaths per 10,000,000 inhabitants). […] The most significant increase was observed for viral etiologies after 2006, affecting people 45 years old and over. […] ALF-related deaths have increased since 2006. […] The trends in ALF-related mortality displayed important increases after 2006. […] The simultaneous increase in all etiologies and across sexes suggests an improvement in the registration of ALF patients, probably resulting from improved access to health care. […] This study was based on administrative data, and some limitations are intrinsic to this methodology. […] In conclusion, in this study, we have shown an increase in the mortality attributable to ALF in Mexico, which was greater in people older than 45 years, with slight geographic variations.

• #15 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  The incidence of ALF is poorly defined but estimated to be approximately 2,000 cases per year in the United States, making it far less common than chronic liver disease. […] There are significant geographical differences in the relative frequency of different causes of ALF across the world. […] The Acute Liver Failure Study Group consists of investigators and coordinators from 23 academic medical centers, all of which perform liver transplants, that receive support from the National Institute of Diabetes, Digestive, and Kidney Diseases to study the epidemiology, outcome and pathogenesis of ALF in the US.

• #16 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #17 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. […] ALF is considered a relatively rare disease, with an annual incidence of 2,000 to 3,000 cases per year. It accounts for 4 to 5% of all liver transplants. […] The course of the disease is variable and unpredictable. The mortality rate is 25 to 30% and the main causes of death are sepsis and cerebral edema. […] The probability of spontaneous recovery or transplant-free survival (TFS) is related to etiology and HE grade. […] The annual reported incidence is from 2,000 to 3,000 cases in the United States. […] In developed countries, paracetamol poisoning predominates in 45 to 55% of cases, with an incidence of 5.5 to 6.2 cases per million per year.

• #18 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure (ALF) is a rare and often heterogeneous presentation of severe liver dysfunction in a patient with otherwise no pre-existing liver disease. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries. […] A recent review of the epidemiology of ALF over the past 50 years reveals the relative incidence of ALF secondary to hepatitis A and B to have declined, while that of acetaminophen to have increased, mainly in the United States and Western Europe.

• #19 Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

  https://www.mdpi.com/2075-4418/13/6/1035

  Viral infections are among the major causes of acute liver failure (ALF) worldwide. […] Despite the plethora of literature available on viral hepatitis and ALF, there is very limited large-scale epidemiologic data on the prevalence, risk factors of progression and outcomes in ALF of viral causes. […] This is important as viral infections remain the leading cause of ALF in the East and in developing countries, while the impact of viral ALF in the West has largely been ameliorated by effective vaccination and sanitization programs. […] Despite the knowledge that several viruses may cause ALF, there is limited global epidemiological data on viral-ALF. […] Some of the reasons behind this are: (i) recent identification of certain viruses as causative agents of liver diseases, (ii) development of better diagnostic assays which allowed for diagnosis of atypical viral agents causing ALF, (iii) the inconsistent implementation of vaccination programs for preventable viral diseases across countries.

• #20 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure (ALF) is a rare and often heterogeneous presentation of severe liver dysfunction in a patient with otherwise no pre-existing liver disease. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries. […] A recent review of the epidemiology of ALF over the past 50 years reveals the relative incidence of ALF secondary to hepatitis A and B to have declined, while that of acetaminophen to have increased, mainly in the United States and Western Europe.

• #21 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  Acute liver failure (ALF) is a serious condition that refers to the development of synthetic function impairment after severe acute liver injury in an individual without pre-existing liver disease. Understanding the epidemiology of ALF in children constitutes a cornerstone in its preventive and treatment plans. Nevertheless, there is a lack of information about its epidemiology in Egypt. […] The aim of this study was to assess the epidemiologic data of ALF in Egyptian children. […] The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Hepatitis A virus (HAV) was the most commonly identifiable etiology (37.7%). Mortality was the outcome for 73 patients (47.4%). […] Hepatitis A virus is the most commonly identified etiology of ALF in Egyptian children. The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission.

• #22 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  Acute liver failure (ALF) is a serious condition that refers to the development of synthetic function impairment after severe acute liver injury in an individual without pre-existing liver disease. Understanding the epidemiology of ALF in children constitutes a cornerstone in its preventive and treatment plans. Nevertheless, there is a lack of information about its epidemiology in Egypt. […] The aim of this study was to assess the epidemiologic data of ALF in Egyptian children. […] The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Hepatitis A virus (HAV) was the most commonly identifiable etiology (37.7%). Mortality was the outcome for 73 patients (47.4%). […] Hepatitis A virus is the most commonly identified etiology of ALF in Egyptian children. The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission.

• #23 Epidemiology of Acute Liver Failure Attributable To Viral Infections in Sub-Saharan Africa: A Systematic Review | Opast Publishing Group

  https://www.opastpublishers.com/peer-review/epidemiology-of-acute-liver-failure-attributable-to-viral-infections-in-subsaharan-africa-a-systematic-review-7582.html

  Viral hepatitis remains the leading cause of acute liver failure (ALF) in Asia and Africa, Sub-Saharan Africa (SSA) inclusive. […] A total of 16,059 articles were identified from our initial search and 11 studies from 6 countries were included in our final analysis. One hundred and fifty-two cases of viral hepatitis-induced ALF were recorded from 1982- 2022. The most frequent causes were hepatitis A virus (HAV) with 62 cases (40.8%), hepatitis E virus (HEV) with 54 cases (35.5%), and hepatitis B virus (HBV) with 18 cases (11.8%). […] In the last four decades, HAV has been the leading cause of viral hepatitis-induced ALF in the pediatric population. HEV and HBV account for cases in adults while HEV is frequently reported in pregnant women. Treatment is mainly supportive; liver transplantation is not readily available, and the case fatality rate remains high. These findings highlight the need for implementing routine HAV immunization in expanded programs on immunization available in SSA, especially for children, and routine screening for HEV in pregnant women in HEV endemic zones.

• #24 A guide to managing acute liver failure | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/6/453

  Nearly 2,000 cases of acute liver failure occur each year in the United States. […] It is more common in women than in men, and more common in white people than in other races. The peak incidence is at a fairly young age, ie, 35 to 45 years. […] The most common cause of acute liver failure in the United States and other Western countries is acetaminophen toxicity, followed by viral hepatitis. […] There are a number of prognostic scores for acute liver failure, but each has limitations. […] Many patients with acute liver failure ultimately require orthotopic liver transplant, especially if they present with severe encephalopathy. […] Patients who present to a center that does not have the facilities for liver transplant should be transferred to a transplant center as soon as possible, preferably by air.

• #25 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  Acute liver failure is seen among all races. In a US multicenter study of acute liver failure, the ethnic distribution included white persons (74%), Hispanics (10%), black persons (3%), Asians (5%), and Latin Americans (2%). […] In a US multicenter study group, acute liver failure was seen more often in women (73%) than in men, and women with acute liver failure were older (39 y) than men (32.5 y). […] Age may be pertinent to morbidity and mortality in those with acute liver failure. Patients younger than 10 years and older than 40 years tend to fare relatively poorly.

• #26 Acute liver failure epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Acute_liver_failure_epidemiology_and_demographics

  The incidence of acute liver failure in the United States is 2000-2300 cases annually. In the year 2009, the diagnosis of acute hepatic necrosis was 420 cases per 100,000 cases of all adult liver transplants in the United States. In the year 1998 to 2008, according to the United States acute liver failure (ALF) registry statistics, the most common cause of acute liver failure was acetaminophen with 46000 cases per 100,000 individuals and 12000 cases per 100,000 individuals for other drugs. Acute hepatitis B is the cause of acute liver failure in 1000 individuals per 100,000 individuals but it increases to 20,000 individuals per 100,000 individuals with hepatitis D virus co-infection. […] Acute liver failure is more common in women than men, and women with acute liver failure were older than men. Women are more commonly affected with autoimmune hepatitis and hepatitis E viral infection than men.

• #27 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  Acute liver failure is seen among all races. In a US multicenter study of acute liver failure, the ethnic distribution included white persons (74%), Hispanics (10%), black persons (3%), Asians (5%), and Latin Americans (2%). […] In a US multicenter study group, acute liver failure was seen more often in women (73%) than in men, and women with acute liver failure were older (39 y) than men (32.5 y). […] Age may be pertinent to morbidity and mortality in those with acute liver failure. Patients younger than 10 years and older than 40 years tend to fare relatively poorly.

• #28 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  Acute liver failure is seen among all races. In a US multicenter study of acute liver failure, the ethnic distribution included white persons (74%), Hispanics (10%), black persons (3%), Asians (5%), and Latin Americans (2%). […] In a US multicenter study group, acute liver failure was seen more often in women (73%) than in men, and women with acute liver failure were older (39 y) than men (32.5 y). […] Age may be pertinent to morbidity and mortality in those with acute liver failure. Patients younger than 10 years and older than 40 years tend to fare relatively poorly.

• #29 Acute liver failure epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Acute_liver_failure_epidemiology_and_demographics

  The acute liver failure is seen more in the white population with 74,000 individuals per 100,000 individuals, 10,000 individuals per 100,000 individuals in the Hispanics, 3000 individuals per 100,000 individuals in the Black population and 5000 individuals per 100,000 individuals in the Asian population. […] The most common cause of acute liver failure in the developed world is acetaminophen toxicity. The acute liver failure secondary to hepatitis B is also on the rise in the developed world due to immigration. […] The most common cause of acute liver failure in the developing countries is viral infection mainly hepatitis A and hepatitis B.

• #30 Epidemiology of Acute Liver Failure | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-82930-8_26

  Acute liver failure (ALF) is a rare clinical syndrome, resulting from rapid loss of hepatic function in a previously healthy young individual. It is defined by the development of coagulopathy and encephalopathy, leading to multiorgan failure with high morbidity and mortality. Over the past decades, improvement in medical management and the introduction of liver transplantation (LT) have dramatically changed the outcome of these patients. In the Western world, ALF accounts for about 7% of LT. A wide range of etiologies can lead to ALF but worldwide viral causes (mainly hepatitis A, B, and E) and drug-induced liver injury (DILI) account for the majority of cases. The prevalence of specific etiologies changes with geographical location and the influence by healthcare interventions such as vaccination programs. The cause of ALF is probably the most significant factor influencing the patients outcome and choice of management.

• #31 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  The overall incidence of ALF in children is unknown. […] The etiology of ALF varies according to the age of patients and the development of the country. […] In resource-rich countries, drug-induced ALF is usually the most common etiology in children, while in resource-limited countries, infectious etiologies are dominant, among which hepatitis A virus (HAV) is the most common. […] The high mortality rate in the first 5 days of admission may be due to the inability to identify the etiology in undiagnosed cases in addition to a lack of awareness about the disease and delayed reference of cases. […] In the present study, different ALF etiologies were significantly associated with mortality. […] The present study demonstrated a significantly higher chance of death if INR exceeds 2.97 with best sensitivity (84%), specificity (70%), and area under the receiver operating characteristic curve (AUROC) (0.826).

• #32 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #33 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #34 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure (ALF) is a rare and often heterogeneous presentation of severe liver dysfunction in a patient with otherwise no pre-existing liver disease. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries. […] A recent review of the epidemiology of ALF over the past 50 years reveals the relative incidence of ALF secondary to hepatitis A and B to have declined, while that of acetaminophen to have increased, mainly in the United States and Western Europe.

• #35 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #36 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #37 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #38 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #39 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #40 The Epidemiology of Acute Liver Failure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7036472/

  The primary conclusion of our analysis is that the incidence of ALF seems to be higher than previously estimated for Germany, comparable with that of the United States, but lower than recently reported for Taiwan and Thailand. […] Despite the high mortality of 47%, liver transplantation was performed in only 3.8% of cases.

• #41 Acute liver failure | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-liver-failure?lang=us

  Acute liver failure is rare, with 1 case per 100,000 in the developed world. […] Mortality is high in acute liver failure at ~50% (range 30-70%) with orthotopic liver transplant considered the definitive treatment. […] The goals of management include identification of reversible causes of acute liver failure, provide organ support to maximize the probability of recovery as well as to perform risk stratification and identify patients for consideration of early liver transplantation, as they may not survive supportive care.

• #42 The Epidemiology of Acute Liver Failure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7036472/

  The primary conclusion of our analysis is that the incidence of ALF seems to be higher than previously estimated for Germany, comparable with that of the United States, but lower than recently reported for Taiwan and Thailand. […] Despite the high mortality of 47%, liver transplantation was performed in only 3.8% of cases.

• #43 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  Acute liver failure (ALF) is a serious condition that refers to the development of synthetic function impairment after severe acute liver injury in an individual without pre-existing liver disease. Understanding the epidemiology of ALF in children constitutes a cornerstone in its preventive and treatment plans. Nevertheless, there is a lack of information about its epidemiology in Egypt. […] The aim of this study was to assess the epidemiologic data of ALF in Egyptian children. […] The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Hepatitis A virus (HAV) was the most commonly identifiable etiology (37.7%). Mortality was the outcome for 73 patients (47.4%). […] Hepatitis A virus is the most commonly identified etiology of ALF in Egyptian children. The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission.

• #44 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  In conclusion, ALF is a rapidly progressive clinical condition with high mortality (47.4%) that occurs mainly in the first 5 days of admission. High values of INR, PTT, TB, ammonia, and creatinine at presentation may be a potential marker for predicting mortality in ALF in children. So, early referral of patients to a pediatric-hepatology specialized center with experience in pediatric liver transplantation is recommended.

• #45 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. […] ALF is considered a relatively rare disease, with an annual incidence of 2,000 to 3,000 cases per year. It accounts for 4 to 5% of all liver transplants. […] The course of the disease is variable and unpredictable. The mortality rate is 25 to 30% and the main causes of death are sepsis and cerebral edema. […] The probability of spontaneous recovery or transplant-free survival (TFS) is related to etiology and HE grade. […] The annual reported incidence is from 2,000 to 3,000 cases in the United States. […] In developed countries, paracetamol poisoning predominates in 45 to 55% of cases, with an incidence of 5.5 to 6.2 cases per million per year.

• #46 Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

  https://www.mdpi.com/2075-4418/13/6/1035

  The importance of knowing the epidemiology of viral ALF extends beyond the design of national programs and preventive healthcare. […] Multiple groups have reported that ALF most commonly presents in the fourth decade of life and is more prevalent in women. […] However, mortality rates vary in different countries owing to the availability of donor livers, the prevalent etiology of ALF and referral practices. […] The survival rates in ALF with expectant management range between 50 and 60%, which may improve to 80% after liver transplant (LT). […] There are multiple reasons why an LT does not ensure survival in all ALF patients, which include: (i) incorrect timing of liver transplant, (ii) post-transplant infections, (iii) recipients’ characteristics, (iv) deficiencies in referral systems with lack of SLU and (v) procedural morbidity and mortality associated with the transplant procedure.

• #47 A guide to managing acute liver failure | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/6/453

  Nearly 2,000 cases of acute liver failure occur each year in the United States. […] It is more common in women than in men, and more common in white people than in other races. The peak incidence is at a fairly young age, ie, 35 to 45 years. […] The most common cause of acute liver failure in the United States and other Western countries is acetaminophen toxicity, followed by viral hepatitis. […] There are a number of prognostic scores for acute liver failure, but each has limitations. […] Many patients with acute liver failure ultimately require orthotopic liver transplant, especially if they present with severe encephalopathy. […] Patients who present to a center that does not have the facilities for liver transplant should be transferred to a transplant center as soon as possible, preferably by air.

• #48 Management of acute liver failure | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2009.127

  Evolution of the clinical syndrome of ALF includes multi-organ-system failure (MOSF), often triggered by infection; the earliest signs of deterioration are elements of the systemic inflammatory response syndrome. […] Clinical trials in ALF are lacking; consequently, intensive care management of affected patients is largely based on experience in other disease entities characterized by cerebral edema, systemic inflammation and MOSF. […] The incidence of cerebral edema and intracranial hypertension in ALF seems to be decreasing, but these conditions portend poor outcome as treatment merely delays brain herniation rather than reverses pathogenesis.

• #49 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  Acute liver failure (ALF) is a rare condition characterized by the abrupt onset of severe liver injury, manifest as a profound liver dysfunction as well as a confusional state called hepatic encephalopathy in individuals with no prior history of liver disease. The lack of prior liver disease is critical to the definition of ALF. […] Despite its relative rarity, ALF is important because it is associated with a high mortality. However, the dismal prognosis associated with ALF appears to be improving, at least in the West. This trend likely reflects the introduction of liver transplantation as a highly effective therapy, improvement in medical intensive care, and a change in the epidemiology of ALF with a shift from causes with a relatively poor prognosis (e.g., hepatitis B) to those with a relatively good prognosis (e.g. acetaminophen overdose).

• #50 Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

  https://www.mdpi.com/2075-4418/13/6/1035

  The importance of knowing the epidemiology of viral ALF extends beyond the design of national programs and preventive healthcare. […] Multiple groups have reported that ALF most commonly presents in the fourth decade of life and is more prevalent in women. […] However, mortality rates vary in different countries owing to the availability of donor livers, the prevalent etiology of ALF and referral practices. […] The survival rates in ALF with expectant management range between 50 and 60%, which may improve to 80% after liver transplant (LT). […] There are multiple reasons why an LT does not ensure survival in all ALF patients, which include: (i) incorrect timing of liver transplant, (ii) post-transplant infections, (iii) recipients’ characteristics, (iv) deficiencies in referral systems with lack of SLU and (v) procedural morbidity and mortality associated with the transplant procedure.

• #51 Acute Liver Failure (ALF) | UCSF Department of Surgery

  https://transplantsurgery.ucsf.edu/condition/acute-liver-failure-alf

  The incidence of ALF is poorly defined but estimated to be approximately 2,000 cases per year in the United States, making it far less common than chronic liver disease. […] There are significant geographical differences in the relative frequency of different causes of ALF across the world. […] The Acute Liver Failure Study Group consists of investigators and coordinators from 23 academic medical centers, all of which perform liver transplants, that receive support from the National Institute of Diabetes, Digestive, and Kidney Diseases to study the epidemiology, outcome and pathogenesis of ALF in the US.

• #52 Syndromic Surveillance of Acute Liver Failure in Emergency Departments (France, 2010-2012) | Knowledge Repository

  https://dev-linux2.syndromicsurveillance.org/syndromic-surveillance-acute-liver-failure-emergency-departments-france-2010-2012

  Syndromic surveillance is usually presented as relevant for event detection. […] In France, besides the national liver transplant data, no surveillance data are available for ALF. […] The aim of our work was to explore the relevance of ED data to describe the main features and assess the burden of ALF. […] The objective of this study was to assess the interest and feasibility of using syndromic surveillance data from emergency departments (ED) for the description of clinical and epidemiological characteristics of patients with acute liver failure (ALF) during the 2010-2012 period in France.

• #53 The global epidemiology of viral-induced acute liver failure: a systematic review protocol | BMJ Open

  https://bmjopen.bmj.com/content/9/8/e029819

  The burden of viral-induced acute liver failure (ALF) around the world still remains unclear, with little to no data collected regarding the disease incidence in general. […] Establishing the common aetiologies of viral-induced ALF, which vary geographically, is important so that: (1) treatment can be initiated quickly, (2) contraindications to liver transplant can be identified, (3) prognoses can be determined more accurately, and most importantly, (4) vaccination against viral ALF aetiologies can be prioritised especially in under-resourced regions with public health risks associated with the relevant attributable diseases. […] The incidence of virally induced ALF has substantially declined in Europe, with only 19% of all ALF cases now related to viral infection. […] The burden of viral-induced ALF around the world still remains unclear, with little to no data collected regarding the disease incidence in general. […] To the best of our knowledge, no extensive systematic review of the global epidemiology of viral-induced ALF has previously been conducted. […] This review aims to describe the global epidemiology of viral-induced ALF.

• #54 Acute Liver Failure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482374/

  Acute liver failure (ALF) is a rare and often heterogeneous presentation of severe liver dysfunction in a patient with otherwise no pre-existing liver disease. […] The etiology and the incidence of ALF vary in developed countries as compared to developing countries. Hepatitis A, B, and E are the leading causes of ALF worldwide and are mostly seen in the developing countries compared to drug-induced liver injury in developed countries. […] A recent review of the epidemiology of ALF over the past 50 years reveals the relative incidence of ALF secondary to hepatitis A and B to have declined, while that of acetaminophen to have increased, mainly in the United States and Western Europe.

• #55 Increased mortality from acute liver failure in Mexico | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-increased-mortality-from-acute-liver-S1665268119310324

  From 1998 to 2009, 2,193 ALF-related deaths were reported. […] A threefold increase in ALF mortality was observed during the period from 1998 to 2009 (the global mortality rate increased from 13.1 to 40.2 deaths per 10,000,000 inhabitants). […] The most significant increase was observed for viral etiologies after 2006, affecting people 45 years old and over. […] ALF-related deaths have increased since 2006. […] The trends in ALF-related mortality displayed important increases after 2006. […] The simultaneous increase in all etiologies and across sexes suggests an improvement in the registration of ALF patients, probably resulting from improved access to health care. […] This study was based on administrative data, and some limitations are intrinsic to this methodology. […] In conclusion, in this study, we have shown an increase in the mortality attributable to ALF in Mexico, which was greater in people older than 45 years, with slight geographic variations.

• #56

  https://link.springer.com/article/10.1007/s11894-008-0023-x

  Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. […] In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. […] Several classification systems have been developed for ALF, with the Kings College criteria most widely used for prediction of OLT. […] Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. […] An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. […] OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. […] Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. […] Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.

• #57 Cirrhosis: Practice Essentials, Overview, Epidemiology

  https://emedicine.medscape.com/article/185856-overview

  Chronic liver disease is common around the world and in the United States. It is believed to affect more than 1.5 billion people worldwide and leads to more than 2 million deaths each year. […] More than 40% of US adults are affected by some type of chronic liver disease, of which the most common causes include metabolic dysfunction-associated steatotic liver disease (MASLD) (30-40%). […] In 2022, 9527 liver transplants were performed in the United States. The following were the most common diagnoses in 9001 adult liver transplant recipients in 2022: ALD: 40.8%, MASH: 19.9%, Other/unknown: 14.5%, HCC: 10.9%, Cholestatic liver disease: 7.1%, Hepatitis C: 4.4%, Acute liver failure: 2.3%. […] The challenge to clinicians caring for patients with cirrhosis is how to implement the strategies that maximize patients’ chances for remaining well-compensated and minimize their risk for liver decompensation.

• #58 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver diseases represent a wide array of disorders characterized by hepatocyte injury, inflammatory cell infiltration, and HSC activation, which cumulatively impair liver function and disrupt its architecture. Annually, liver diseases are linked to approximately 2 million deaths and account for 4% of global mortality. Acute liver diseases often result from hepatotropic virus infections, though drug-induced liver injury (DILI) is also becoming increasingly prevalent worldwide. Chronic liver conditions, on the other hand, typically arise from factors like alcohol consumption, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections, along with a rising incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) globally. Progression from such chronic conditions to end-stage liver diseases, including cirrhosis and liver cancer, contributes significantly to morbidity and mortality.

• #59 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Liver disease stands as a leading cause of global mortality. The Global Burden of Disease 2019 study reported that 1.26 million individuals succumbed to cirrhosis and other chronic liver diseases in 2019, marking a 13% increase since 1990. Liver cancer, a terminal outcome of liver disease, accounted for approximately 830,000 deaths in 2020, representing 8.3% of global cancer-related deaths. Viral hepatitis, especially HBV and HCV, annually leads to around 1.3 million deaths. Moreover, approximately 3.3 million people are diagnosed with alcohol-associated liver disease (ALD) annually, accounting for 5.9% of global deaths. The rising fatalities from MASLD are also noteworthy, with an estimated 280,000 deaths in 2019. Notably, liver disease mortality rates show significant regional disparities; for example, Mongolia reports the highest liver cancer mortality rate at 71.0 per 100,000 individuals, compared to 6.6 in the United States (U.S.).

• #60 Acute Liver Failure | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14108/all/Acute_Liver_Failure?q=Hypoglycemia

  Exact frequency of ALF in children is unknown but accounts for 10-15% of pediatric liver transplants in the United States annually. […] In infants and children 3 years of age, indeterminate and metabolic etiologies predominate. […] In older children, drug-induced toxicity (especially acetaminophen), autoimmune hepatitis become more common. […] Infectious etiologies (e.g., viral hepatitis) vary in prevalence based on geographic region.

• #61 Acute Liver Failure | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14108/all/Acute_Liver_Failure?q=Hypoglycemia

  Exact frequency of ALF in children is unknown but accounts for 10-15% of pediatric liver transplants in the United States annually. […] In infants and children 3 years of age, indeterminate and metabolic etiologies predominate. […] In older children, drug-induced toxicity (especially acetaminophen), autoimmune hepatitis become more common. […] Infectious etiologies (e.g., viral hepatitis) vary in prevalence based on geographic region.

• #62 Acute Liver Failure | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14108/all/Acute_Liver_Failure?q=Hypoglycemia

  Exact frequency of ALF in children is unknown but accounts for 10-15% of pediatric liver transplants in the United States annually. […] In infants and children 3 years of age, indeterminate and metabolic etiologies predominate. […] In older children, drug-induced toxicity (especially acetaminophen), autoimmune hepatitis become more common. […] Infectious etiologies (e.g., viral hepatitis) vary in prevalence based on geographic region.

• #63 Acute Liver Failure | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14108/all/Acute_Liver_Failure?q=Hypoglycemia

  Exact frequency of ALF in children is unknown but accounts for 10-15% of pediatric liver transplants in the United States annually. […] In infants and children 3 years of age, indeterminate and metabolic etiologies predominate. […] In older children, drug-induced toxicity (especially acetaminophen), autoimmune hepatitis become more common. […] Infectious etiologies (e.g., viral hepatitis) vary in prevalence based on geographic region.

• #64 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  Acute liver failure (ALF) is a serious condition that refers to the development of synthetic function impairment after severe acute liver injury in an individual without pre-existing liver disease. Understanding the epidemiology of ALF in children constitutes a cornerstone in its preventive and treatment plans. Nevertheless, there is a lack of information about its epidemiology in Egypt. […] The aim of this study was to assess the epidemiologic data of ALF in Egyptian children. […] The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Hepatitis A virus (HAV) was the most commonly identifiable etiology (37.7%). Mortality was the outcome for 73 patients (47.4%). […] Hepatitis A virus is the most commonly identified etiology of ALF in Egyptian children. The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission.

• #65 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

  The incidence of fulminant hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. […] In developed nations, acute liver failure has an estimated incidence of fewer than 10 cases per million people per year. […] Hepatitis E virus (HEV) is associated with a high incidence of fulminant hepatic failure in women who are pregnant and is of concern in pregnant patients living in or traveling through endemic areas.

• #66 Epidemiology of Acute Liver Failure Attributable To Viral Infections in Sub-Saharan Africa: A Systematic Review | Opast Publishing Group

  https://www.opastpublishers.com/peer-review/epidemiology-of-acute-liver-failure-attributable-to-viral-infections-in-subsaharan-africa-a-systematic-review-7582.html

  Viral hepatitis remains the leading cause of acute liver failure (ALF) in Asia and Africa, Sub-Saharan Africa (SSA) inclusive. […] A total of 16,059 articles were identified from our initial search and 11 studies from 6 countries were included in our final analysis. One hundred and fifty-two cases of viral hepatitis-induced ALF were recorded from 1982- 2022. The most frequent causes were hepatitis A virus (HAV) with 62 cases (40.8%), hepatitis E virus (HEV) with 54 cases (35.5%), and hepatitis B virus (HBV) with 18 cases (11.8%). […] In the last four decades, HAV has been the leading cause of viral hepatitis-induced ALF in the pediatric population. HEV and HBV account for cases in adults while HEV is frequently reported in pregnant women. Treatment is mainly supportive; liver transplantation is not readily available, and the case fatality rate remains high. These findings highlight the need for implementing routine HAV immunization in expanded programs on immunization available in SSA, especially for children, and routine screening for HEV in pregnant women in HEV endemic zones.

• #67 Thieme E-Journals – Seminars in Liver Disease / Abstract

  https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0036-1583201

  Chronic liver disease and cirrhosis, a common end result of viral hepatitis, alcohol abuse, and the emerging epidemic of nonalcoholic fatty liver disease are a significant source of morbidity and premature mortality globally. […] Although a uniformly accepted definition for epidemiological studies is lacking, acute-on-chronic liver failure (ACLF) is increasingly recognized as an important source of disease burden. […] At least in the United States, hospitalizations for ACLF have increased several fold in the last decade and have a high fatality rate. […] Acute-on-chronic liver failure incurs extremely high costs, exceeding the yearly costs of inpatient management of other common medical conditions. […] Although further epidemiological data are needed to better understand the true impact and future trends of ACLF, these data point to the urgency in the clinical investigation for ACLF and the deployment of healthcare resources for timely and effective interventions in affected patients.

• #68 The Epidemiology of Acute Liver Failure (24.01.2020)

  https://di.aerzteblatt.de/int/archive/article/212054

  Acute liver failure (ALF) is a life-threatening event associated with high mortality. Currently, only estimates are available for its incidence. The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the largest statutory health insurance company, which represents 26.5 million people. […] The calculated incidence of ALF was 1.13/100 000 person-years, representing 4652 cases. […] The incidence of ALF was higher than previously estimated for Germany, with only a very low rate of LT despite high mortality. […] Since there are no national registries, the true incidence is unknown. Currently, only estimates based on cohort studies are available, while population-based data are rare. […] In total, 4652 cases of ALF were identified in the period from 1 January 2014 to 31 December 2018, resulting in a mean incidence of 1.13 per 100 000 person-years.

• #69 The global epidemiology of viral-induced acute liver failure: a systematic review protocol | BMJ Open

  https://bmjopen.bmj.com/content/9/8/e029819

  The burden of viral-induced acute liver failure (ALF) around the world still remains unclear, with little to no data collected regarding the disease incidence in general. […] Establishing the common aetiologies of viral-induced ALF, which vary geographically, is important so that: (1) treatment can be initiated quickly, (2) contraindications to liver transplant can be identified, (3) prognoses can be determined more accurately, and most importantly, (4) vaccination against viral ALF aetiologies can be prioritised especially in under-resourced regions with public health risks associated with the relevant attributable diseases. […] The incidence of virally induced ALF has substantially declined in Europe, with only 19% of all ALF cases now related to viral infection. […] The burden of viral-induced ALF around the world still remains unclear, with little to no data collected regarding the disease incidence in general. […] To the best of our knowledge, no extensive systematic review of the global epidemiology of viral-induced ALF has previously been conducted. […] This review aims to describe the global epidemiology of viral-induced ALF.

• #70 Liver diseases: epidemiology, causes, trends and predictions | Signal Transduction and Targeted Therapy

  https://www.nature.com/articles/s41392-024-02072-z

  Determining the precise incidence of DILI is challenging due to diagnostic complexities and widespread underreporting. The estimates of DILI incidence fluctuate significantly, from 1 in 10,000 to 1 in 1,000,000 cases, influenced by variable factors such as diagnostic criteria, detection capabilities, population demographics, drug types, cultural factors, and reporting practices. In Europe, retrospective studies from the U.K. and Sweden suggest an annual incidence of DILI around 2.3-2.4 per 100,000 individuals. […] In summary, liver diseases, including acute liver failure, are a significant global health concern, with rising incidence and mortality rates, particularly from lifestyle-associated conditions such as MASLD and ALD.

• #71 Thieme E-Journals – Seminars in Liver Disease / Abstract

  https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0036-1583201

  Chronic liver disease and cirrhosis, a common end result of viral hepatitis, alcohol abuse, and the emerging epidemic of nonalcoholic fatty liver disease are a significant source of morbidity and premature mortality globally. […] Although a uniformly accepted definition for epidemiological studies is lacking, acute-on-chronic liver failure (ACLF) is increasingly recognized as an important source of disease burden. […] At least in the United States, hospitalizations for ACLF have increased several fold in the last decade and have a high fatality rate. […] Acute-on-chronic liver failure incurs extremely high costs, exceeding the yearly costs of inpatient management of other common medical conditions. […] Although further epidemiological data are needed to better understand the true impact and future trends of ACLF, these data point to the urgency in the clinical investigation for ACLF and the deployment of healthcare resources for timely and effective interventions in affected patients.

• #72 The Epidemiology of Acute Liver Failure (24.01.2020)

  https://di.aerzteblatt.de/int/archive/article/212054

  Acute liver failure (ALF) is a life-threatening event associated with high mortality. Currently, only estimates are available for its incidence. The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the largest statutory health insurance company, which represents 26.5 million people. […] The calculated incidence of ALF was 1.13/100 000 person-years, representing 4652 cases. […] The incidence of ALF was higher than previously estimated for Germany, with only a very low rate of LT despite high mortality. […] Since there are no national registries, the true incidence is unknown. Currently, only estimates based on cohort studies are available, while population-based data are rare. […] In total, 4652 cases of ALF were identified in the period from 1 January 2014 to 31 December 2018, resulting in a mean incidence of 1.13 per 100 000 person-years.

• #73

  https://journals.lww.com/ajg/fulltext/2007/11000/population_based_surveillance_for_acute_liver.19.aspx

  Most U.S. studies of acute liver failure (ALF) patients have been conducted at tertiary care liver transplantation centers. The aim of this study was to conduct population-based surveillance for ALF. […] We conducted population-based surveillance for ALF within the 8 counties comprising Metropolitan Atlanta between November 2000 and October 2004. […] A total of 65 cases were enrolled, yielding an annualized incidence for all causes of ALF of 5.5 (95% CI 4.37.0) per million. […] Our population-based study suggests approximately 1,600 ALF cases occur in the United States each year.

• #74 Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

  https://www.mdpi.com/2075-4418/13/6/1035

  Viral infections are among the major causes of acute liver failure (ALF) worldwide. […] Despite the plethora of literature available on viral hepatitis and ALF, there is very limited large-scale epidemiologic data on the prevalence, risk factors of progression and outcomes in ALF of viral causes. […] This is important as viral infections remain the leading cause of ALF in the East and in developing countries, while the impact of viral ALF in the West has largely been ameliorated by effective vaccination and sanitization programs. […] Despite the knowledge that several viruses may cause ALF, there is limited global epidemiological data on viral-ALF. […] Some of the reasons behind this are: (i) recent identification of certain viruses as causative agents of liver diseases, (ii) development of better diagnostic assays which allowed for diagnosis of atypical viral agents causing ALF, (iii) the inconsistent implementation of vaccination programs for preventable viral diseases across countries.

• #75 Acute Liver Failure: Evidence-Based Evaluation and Management – emDocs

  https://www.emdocs.net/acute-liver-failure-evidence-based-evaluation-and-management/

  Acute liver failure (ALF) is a rare clinical presentation in the ED, it carries a high mortality, morbidity, and resource cost. […] Surveillance reports from the developed world suggest an overall incidence between one and six cases per million people every year, or around a total of 2,000 cases per year. […] The most common cause of ALF in the U.S. is acetaminophen toxicity, treated by N-acetylcysteine. […] The management of ALF involves: identification of the etiology of ALF whenever possible and initiation of specific treatment, supportive and symptomatic management of ALF, with timely transfer to the critical care unit, and early consultation with liver transplant specialists and transfer of patients to a liver transplant center when necessary. […] There are many prognostic tools for patients who present with ALF, but the two most common are the King’s College criteria, and the Model for End-Stage Liver Disease (MELD) score.

• #76 Assessing Liver Function in Rat Models of Acute Liver Failure Using Single-Photon Emission Computed Tomography and Cytokine Levels | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323531

  In recent years, hepatobiliary scintigraphy has been increasingly recognized as an effective method for assessing hepatic function. […] Given that previous studies have often focused on a single liver injury model, we intended to explore more causes of liver injury, so we established separate experimental models for the D-GalN+LPS, partial hepatectomy, and common bile duct ligation. As research on dynamic hepatobiliary scintigraphy grows, its application in assessing liver function gains increasing attention. However, its precise value in evaluating liver function and its correlation with changes in liver function remain unclear. […] Acute liver failure is a rare condition with diverse etiologies. It is characterized by extensive hepatocyte necrosis, severe liver dysfunction, and rapid disease deterioration, and often results in high morbidity and mortality. Typical clinical workup relies on serum biochemical tests and ChildPugh classification for early diagnosis and liver function assessment. However, these commonly used methods assess total liver function indirectly and may not always provide pertinent insights, particularly when assessment of regional liver function is crucial.

• #77 Assessing Liver Function in Rat Models of Acute Liver Failure Using Single-Photon Emission Computed Tomography and Cytokine Levels | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323531

  Therefore, there is a need to explore radiological approaches, with nuclear medicine imaging emerging as a promising avenue for directly assessing liver function. SPECT is a commonly used nuclear medicine imaging modality for liver function assessment. […] Dynamic hepatobiliary SPECT imaging is a valuable imaging tool for diagnosis and assessing the severity of different types of liver failure. It offers noninvasive and direct monitoring of liver function. SPECT imaging, combined with the calculated indexes and the evaluation of cytokine levels, can become an effective method for assessing liver function of patients with acute liver failure.

• #78 Prognostic Scores in Acute Liver Failure Due to Viral Hepatitis

  https://www.mdpi.com/2075-4418/13/6/1035

  The timing of the LT is a very pertinent but unanswered question in the management of ALF, despite the immense research and literature available on the subject. […] Current guidelines advocate that all patients should be considered for LT if they deteriorate clinically and should be referred to an SLU for specialized care while awaiting a transplant. […] The impact of referral to an SLU in improving outcomes in these patients has also been noted in recent studies. […] Thus, when faced with a patient presenting with ALF, the clinician should be able to answer the following questions: (i) whether the patient require a liver transplant or expectant management; (ii) how to objectively identify parameters which would enable to identify those in need of LT; and (iii) how frequently these objective parameters should be reassessed in a patient. […] Prognostic scoring systems can help answer these in ALF patients. […] Several such prognostic systems are available, each with its benefits and shortcomings, which are discussed in this review article with respect to their use in viral-ALF.

• #79 Acute liver failure: Management update and prognosis | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-acute-liver-failure-management-update-articulo-S2255534X24000628

  There is not much information on the epidemiology of ALF in Mexico. An increase in incidence and mortality attributable to viral causes of ALF have been seen in the country, but those observations are based on retrospective studies utilizing national registers, making them susceptible to information biases and variations in detection, depending on access to healthcare services. […] The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. […] Identifying the cause is crucial, given that it influences prognosis and treatment.

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