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Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis. J Clin Exp Hepatol. 2020;10(4):339-376doi: 10.1016/j.jceh.2020.04.012.
Anand, A. C., Nandi, B., Acharya, S. K., Arora, A., Babu, S., Batra, Y., Chawla, Y. K., Chowdhury, A., Chaoudhuri, A., Eapen, E. C., Devarbhavi, H., Dhiman, R., Datta Gupta, S., Duseja, A., Jothimani, D., Kapoor, D., Kar, P., Khuroo, M. S., Kumar, A., Madan, K., Mallick, B., Maiwall, R., Mohan, N., Nagral, A., Nath, P., Panigrahi, S. C., Pawar, A., Philips, C. A., Prahraj, D., Puri, P., Rastogi, A., Saraswat, V. A., Saigal, S., Shalimar, Shukla, A., Singh, S. P., Verghese, T., Wadhawan, M. (2020). Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis. Journal of clinical and experimental hepatology, 10(4), 339-376. https://doi.org/10.1016/j.jceh.2020.04.012
Anand, Anil C, et al. "Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis." Journal of clinical and experimental hepatology vol. 10,4 (2020): 339-376. doi: https://doi.org/10.1016/j.jceh.2020.04.012
Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, Chawla YK, Chowdhury A, Chaoudhuri A, Eapen EC, Devarbhavi H, Dhiman R, Datta Gupta S, Duseja A, Jothimani D, Kapoor D, Kar P, Khuroo MS, Kumar A, Madan K, Mallick B, Maiwall R, Mohan N, Nagral A, Nath P, Panigrahi SC, Pawar A, Philips CA, Prahraj D, Puri P, Rastogi A, Saraswat VA, Saigal S, Shalimar, Shukla A, Singh SP, Verghese T, Wadhawan M. Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis. J Clin Exp Hepatol. 2020 Jul-Aug;10(4):339-376. doi: 10.1016/j.jceh.2020.04.012. Epub 2020 Apr 28. PMID: 32655238; PMCID: PMC7335721.
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J Clin Exp Hepatol. 2020 Jul-Aug;10(4):339-376. doi: 10.1016/j.jceh.2020.04.012. Epub 2020 Apr 28.

Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis.

Journal of clinical and experimental hepatology

Anil C Anand, Bhaskar Nandi, Subrat K Acharya, Anil Arora, Sethu Babu, Yogesh Batra, Yogesh K Chawla, Abhijit Chowdhury, Ashok Chaoudhuri, Eapen C Eapen, Harshad Devarbhavi, RadhaKrishan Dhiman, Siddhartha Datta Gupta, Ajay Duseja, Dinesh Jothimani, Dharmesh Kapoor, Premashish Kar, Mohamad S Khuroo, Ashish Kumar, Kaushal Madan, Bipadabhanjan Mallick, Rakhi Maiwall, Neelam Mohan, Aabha Nagral, Preetam Nath, Sarat C Panigrahi, Ankush Pawar, Cyriac A Philips, Dibyalochan Prahraj, Pankaj Puri, Amit Rastogi, Vivek A Saraswat, Sanjiv Saigal, Shalimar, Akash Shukla, Shivaram P Singh, Thomas Verghese, Manav Wadhawan,

Affiliations

  1. Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India.
  2. Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India.
  3. Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India.
  4. Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
  5. Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad 500003, India.
  6. Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India.
  7. Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India.
  8. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India.
  9. Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India.
  10. Department of Hepatology, Christian Medical College, Vellore, India.
  11. Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India.
  12. Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
  13. Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
  14. Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India.
  15. Gleneagles Global Hospitals, Hyderabad, Telangana, India.
  16. Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India.
  17. Department of Gastroenterology, Dr Khuroo' S Medical Clinic, Srinagar, Kashmir, India.
  18. Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India.
  19. Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India.
  20. Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India.
  21. Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta - the Medicity Hospital, Sector - 38, Gurgaon, Haryana, India.
  22. Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India.
  23. Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India.
  24. The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, 682028, Kerala, India.
  25. Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India.
  26. Department of Liver Transplantation, Medanta - the MedicityHospital, Sector - 38, Gurgaon, Haryana, India.
  27. Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India.
  28. Department of Hepatology, Department of Liver Transplantation, India.
  29. Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India.
  30. Department of Gastroenterology, LTM Medical College & Sion Hospital, India.
  31. Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India.
  32. Department of Gastroenterology, Government Medical College, Kozikhode, India.
  33. Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India.

PMID: 32655238 PMCID: PMC7335721 DOI: 10.1016/j.jceh.2020.04.012

Abstract

Acute liver failure (ALF) is an infrequent, unpredictable, potentially fatal complication of acute liver injury (ALI) consequent to varied etiologies. Etiologies of ALF as reported in the literature have regional differences, which affects the clinical presentation and natural course. In this part of the consensus article designed to reflect the clinical practices in India, disease burden, epidemiology, clinical presentation, monitoring, and prognostication have been discussed. In India, viral hepatitis is the most frequent cause of ALF, with drug-induced hepatitis due to antituberculosis drugs being the second most frequent cause. The clinical presentation of ALF is characterized by jaundice, coagulopathy, and encephalopathy. It is important to differentiate ALF from other causes of liver failure, including acute on chronic liver failure, subacute liver failure, as well as certain tropical infections which can mimic this presentation. The disease often has a fulminant clinical course with high short-term mortality. Death is usually attributable to cerebral complications, infections, and resultant multiorgan failure. Timely liver transplantation (LT) can change the outcome, and hence, it is vital to provide intensive care to patients until LT can be arranged. It is equally important to assess prognosis to select patients who are suitable for LT. Several prognostic scores have been proposed, and their comparisons show that indigenously developed dynamic scores have an edge over scores described from the Western world. Management of ALF will be described in part 2 of this document.

© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.

Keywords: ACLF, acute on chronic liver failure; AFLP, acute fatty liver of pregnancy; AKI, Acute kidney injury; ALF, Acute liver failure; ALFED, Acute Liver Failure Early Dynamic; ALT, alanine transaminase; ANA, antinuclear antibody; AP, Alkaline phosphatase; APTT, activated partial thromboplastin time; ASM, alternative system of medicine; ASMA, antismooth muscle antibody; AST, aspartate transaminase; ATN, Acute tubular necrosis; ATP, adenosine triphosphate; ATT, anti-TB therapy; AUROC, Area under the receiver operating characteristics curve; BCS, Budd-Chiari syndrome; BMI, body mass index; CBF, cerebral blood flow; CBFV, cerebral blood flow volume; CE, cerebral edema; CHBV, chronic HBV; CLD, chronic liver disease; CNS, central nervous system; CPI, clinical prognostic indicator; CSF, cerebrospinal fluid; DAMPs, Damage-associated molecular patterns; DILI, drug-induced liver injury; EBV, Epstein-Barr virus; ETCO2, End tidal CO2; GRADE, Grading of Recommendations Assessment Development and Evaluation; HAV, hepatitis A virus; HBV, Hepatitis B virus; HELLP, hemolysis; HEV, hepatitis E virus; HLH, Hemophagocytic lymphohistiocytosis; HSV, herpes simplex virus; HV, hepatic vein; HVOTO, hepatic venous outflow tract obstruction; IAHG, International Autoimmune Hepatitis Group; ICH, intracerebral hypertension; ICP, intracerebral pressure; ICU, intensive care unit; IFN, interferon; IL, interleukin; IND-ALF, ALF of indeterminate etiology; INDILI, Indian Network for DILI; KCC, King's College Criteria; LC, liver cirrhosis; LDLT, living donor liver transplantation; LT, liver transplantation; MAP, mean arterial pressure; MHN, massive hepatic necrosis; MPT, mitochondrial permeability transition; MUAC, mid-upper arm circumference; NAPQI, n-acetyl-p-benzo-quinone-imine; NPV, negative predictive value; NWI, New Wilson's Index; ONSD, optic nerve sheath diameter; PAMPs, pathogen-associated molecular patterns; PCR, polymerase chain reaction; PELD, Pediatric End-Stage Liver Disease; PPV, positive predictive value; PT, prothrombin time; RAAS, renin–angiotensin–aldosterone system; SHF, subacute hepatic failure; SIRS, systemic inflammatory response syndrome; SNS, sympathetic nervous system; TB, tuberculosis; TCD, transcranial Doppler; TGF, tumor growth factor; TJLB, transjugular liver biopsy; TLR, toll-like receptor; TNF, tumor necrosis factor; TSFT, triceps skin fold thickness; US, ultrasound; USALF, US Acute Liver Failure; VZV, varicella-zoster virus; WD, Wilson disease; Wilson disease (WD); YP, yellow phosphorus; acute liver failure; autoimmune hepatitis (AIH); drug-induced liver injury; elevated liver enzymes, low platelets; sALI, severe acute liver injury; viral hepatitis

Conflict of interest statement

The authors have none to declare.

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