关键词： 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

来  源：   DOI：10.1016/j.jceh.2020.04.012   PDF(Sci-hub)   PDF(Pubmed)

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.
摘要：
急性肝衰竭（ALF）是罕见的，不可预测的,各种病因导致的急性肝损伤（ALI）的潜在致命并发症。文献中报道的ALF病因具有区域差异，影响临床表现和自然病程。在旨在反映印度临床实践的共识文章的这一部分中，疾病负担,流行病学,临床表现,监测,和预测已经讨论过了。在印度,病毒性肝炎是ALF的最常见原因，抗结核药物引起的药物性肝炎是第二常见的原因。ALF的临床表现以黄疸为特征,凝血病,和脑病。区分ALF和其他肝衰竭的原因是很重要的，包括慢性急性肝衰竭，亚急性肝功能衰竭,以及某些可以模仿这种表现的热带感染。该疾病通常具有暴发性临床过程，短期死亡率很高。死亡通常归因于脑部并发症，感染,导致多器官衰竭。及时肝移植（LT）可以改变结果，因此，在可以安排LT之前，为患者提供重症监护至关重要。评估预后以选择适合LT的患者同样重要。已经提出了几个预后评分，他们的比较表明，本土开发的动态分数比西方世界描述的分数更具优势。ALF的管理将在本文件的第2部分中描述。
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