Acute liver failure in Lithuania

Dalia Adukauskienė, Ilona Dockienė, Rima Naginienė¹, Egidijus Kėvelaitis², Juozas Pundzius³, Limas Kupčinskas⁴

Department of Intensive Care, ¹Laboratory of Environmental Health Research, Institute for Biomedical Research, ²Department of Physiology, ³Department of Surgery, ⁴Department of Gastroenterology, Kaunas University of Medicine, Lithuania

Key words: acute liver failure; etiology; survival; liver transplantation; prognostic criteria.

Summary. Objectives. Acute liver failure (ALF) is a life-threatening condition that can rapidly progress into coma and death due to the cerebral edema and multi-organ dysfunction. The ALF etiology and risk factors have been investigated in West Europe, North America, and Asia; however, there are still no published data about the causes and prognosis of ALF in Central and East European countries. The aim of our study was to analyze the causes, outcomes, and prognostic factors of ALF in patients referred to tertiary care center in Lithuania.

Material and methods. A total of 28 consecutive patients admitted to the tertiary care center (one of two university-level medical centers in Lithuania) over the period of January 1996 and December 2004 and who fulfilled the entry criteria of ALF (presence of hepatic encephalopathy (HE) and prothrombin international normalized ratio (INR) >1.5) were included into a prospective study.

Results. In our study the most frequent causes of ALF were acute viral hepatitis B (21.4 %), drug-induced hepatitis (21.4%), and indeterminate hepatitis (17.9%); other etiologies included Budd-Chiari syndrome (10.7%), ischemic hepatitis (10.7%), Wilson’s disease (7.1%), Amanita phalloides-induced liver damage (3.6%), acute fatty liver of pregnancy (3.6%), and malignant infiltration of the liver (3.6%). Among patients with drug-induced liver injury, only one case of acetaminophen poisoning was diagnosed. Clinical status of 9 persons in all patients with ALF corresponded to criteria for liver transplantation (LT) (one liver transplantation was performed), 6 of them had contraindications, and 13 patients did not fulfill requirements for urgent LT. The patients’ survival rate in these groups was 11.1%, 16.7% and 69.2%, respectively. In 27 non-transplanted patients univariate analysis revealed the grade of HE on the day of enrolment, total serum bilirubin, pH, and prothrombin INR as risk factors for death from ALF. Multivariate logistic regressive analysis determined only prothrombin INR >3.24 and serum pH ≤7.29 as independent predictors of lethal outcome in ALF.

Conclusions. Acute viral hepatitis B, drug-induced liver injury, and indeterminate hepatitis are the main ALF causes in Lithuania. In non-transplanted patients, the main predictors of lethal outcome were severe coagulopathy and metabolic acidosis. Improvement of liver donation system for urgent liver transplantation is essential requirement for amelioration of ALF patient’s survival.

Correspondence to D. Adukauskienė, Department of Intensive Care, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: daliaadu@gmail.com

Received 9 May 2008, accepted 4 July 2008