Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis

Ryan M. Taylor, Shannan Tujios, Kartik Jinjuvadia, Timothy Davern, Obaid S. Shaikh, Steve Han, Raymond T. Chung, William M. Lee, Robert J. Fontana

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Aims The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes. Methods Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis. Results Ischemic hepatitis accounted for 51 (4.4%) of the 1147 ALF patients enrolled. Mean age was 50 years, 63% were female, and only 31% had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69%. Three-week spontaneous survival was 71%, two patients (4%) underwent liver transplantation, and the remaining 13 patients (25%) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95% CI 1.1-1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95% CI 1.1-66.5, P = 0.04). Nineteen of the 28 short-term survivors (68%) were still alive at a median follow-up of 3.7 years whereas nine (32%) others had died at a median follow-up of 2 months. Conclusions A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)777-785
Number of pages9
JournalDigestive Diseases and Sciences
Volume57
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Acute Liver Failure
Hepatitis
Brain Diseases
Phosphates
Survival
Liver Transplantation
Survivors
Heart Diseases
Cohort Studies
Multivariate Analysis
Ischemia
Morbidity
Mortality
Liver
Incidence
Serum

Keywords

  • Aminotransferase levels
  • Coagulopathy
  • Encephalopathy
  • Hypoxic hepatitis
  • Liver transplantation

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis. / Taylor, Ryan M.; Tujios, Shannan; Jinjuvadia, Kartik; Davern, Timothy; Shaikh, Obaid S.; Han, Steve; Chung, Raymond T.; Lee, William M.; Fontana, Robert J.

In: Digestive Diseases and Sciences, Vol. 57, No. 3, 03.2012, p. 777-785.

Research output: Contribution to journalArticle

Taylor, RM, Tujios, S, Jinjuvadia, K, Davern, T, Shaikh, OS, Han, S, Chung, RT, Lee, WM & Fontana, RJ 2012, 'Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis', Digestive Diseases and Sciences, vol. 57, no. 3, pp. 777-785. https://doi.org/10.1007/s10620-011-1918-1
Taylor, Ryan M. ; Tujios, Shannan ; Jinjuvadia, Kartik ; Davern, Timothy ; Shaikh, Obaid S. ; Han, Steve ; Chung, Raymond T. ; Lee, William M. ; Fontana, Robert J. / Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis. In: Digestive Diseases and Sciences. 2012 ; Vol. 57, No. 3. pp. 777-785.
@article{1ed4375f0b4d482dbe1444ad30527d55,
title = "Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis",
abstract = "Aims The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes. Methods Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis. Results Ischemic hepatitis accounted for 51 (4.4{\%}) of the 1147 ALF patients enrolled. Mean age was 50 years, 63{\%} were female, and only 31{\%} had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69{\%}. Three-week spontaneous survival was 71{\%}, two patients (4{\%}) underwent liver transplantation, and the remaining 13 patients (25{\%}) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95{\%} CI 1.1-1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95{\%} CI 1.1-66.5, P = 0.04). Nineteen of the 28 short-term survivors (68{\%}) were still alive at a median follow-up of 3.7 years whereas nine (32{\%}) others had died at a median follow-up of 2 months. Conclusions A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.",
keywords = "Aminotransferase levels, Coagulopathy, Encephalopathy, Hypoxic hepatitis, Liver transplantation",
author = "Taylor, {Ryan M.} and Shannan Tujios and Kartik Jinjuvadia and Timothy Davern and Shaikh, {Obaid S.} and Steve Han and Chung, {Raymond T.} and Lee, {William M.} and Fontana, {Robert J.}",
year = "2012",
month = "3",
doi = "10.1007/s10620-011-1918-1",
language = "English (US)",
volume = "57",
pages = "777--785",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis

AU - Taylor, Ryan M.

AU - Tujios, Shannan

AU - Jinjuvadia, Kartik

AU - Davern, Timothy

AU - Shaikh, Obaid S.

AU - Han, Steve

AU - Chung, Raymond T.

AU - Lee, William M.

AU - Fontana, Robert J.

PY - 2012/3

Y1 - 2012/3

N2 - Aims The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes. Methods Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis. Results Ischemic hepatitis accounted for 51 (4.4%) of the 1147 ALF patients enrolled. Mean age was 50 years, 63% were female, and only 31% had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69%. Three-week spontaneous survival was 71%, two patients (4%) underwent liver transplantation, and the remaining 13 patients (25%) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95% CI 1.1-1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95% CI 1.1-66.5, P = 0.04). Nineteen of the 28 short-term survivors (68%) were still alive at a median follow-up of 3.7 years whereas nine (32%) others had died at a median follow-up of 2 months. Conclusions A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.

AB - Aims The purpose of this study is to describe the incidence and presenting features of patients with acute liver failure (ALF) due to ischemic hepatitis and the prognostic factors associated with short (three-week) and long-term outcomes. Methods Retrospective cohort analysis of adult patients enrolled in the Acute Liver Failure Study Group between 1998 and 2008 with ALF due to ischemic hepatitis. Predictors of adverse outcomes three weeks after presentation were identified by univariate and multivariate analysis. Results Ischemic hepatitis accounted for 51 (4.4%) of the 1147 ALF patients enrolled. Mean age was 50 years, 63% were female, and only 31% had known heart disease before presentation. However, a cardiopulmonary precipitant of hepatic ischemia was identified in 69%. Three-week spontaneous survival was 71%, two patients (4%) underwent liver transplantation, and the remaining 13 patients (25%) died of multi-organ failure. Adverse outcomes were more frequent in subjects with higher admission phosphate levels (HR 1.3, 95% CI 1.1-1.6, P = 0.008) and in subjects with grade 3/4 encephalopathy at presentation (HR: 8.4, 95% CI 1.1-66.5, P = 0.04). Nineteen of the 28 short-term survivors (68%) were still alive at a median follow-up of 3.7 years whereas nine (32%) others had died at a median follow-up of 2 months. Conclusions A higher admission serum phosphate level and more advanced encephalopathy are associated with a lower likelihood of short-term survival of hospitalized patients with ALF due to ischemic hepatitis. Long-term outcomes are largely determined by underlying cardiovascular morbidity and mortality.

KW - Aminotransferase levels

KW - Coagulopathy

KW - Encephalopathy

KW - Hypoxic hepatitis

KW - Liver transplantation

UR - http://www.scopus.com/inward/record.url?scp=84859482244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859482244&partnerID=8YFLogxK

U2 - 10.1007/s10620-011-1918-1

DO - 10.1007/s10620-011-1918-1

M3 - Article

VL - 57

SP - 777

EP - 785

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 3

ER -