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Abstract：
Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug-induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors.
摘要：
急性肝衰竭（ALF）是急性肝炎等常见疾病的罕见并发症。在印度，病毒性肝炎和抗结核药物引起的肝毒性是ALF的最常见原因。临床上,这些患者出现黄疸，脑病,和凝血病。肝性脑病（HE）和脑水肿是ALF过程中最重要的临床事件，其次是额外的感染，并确定这些患者的预后。ALF中脑病和脑水肿的发病机制是独特且多因素的。氨在发病机制中起着至关重要的作用，几种疗法旨在纠正这种异常。新型氨降低剂的作用仍在不断发展。这些患者最好在拥有肝移植（LT）设施的三级医院进行治疗。据记载，积极的强化医疗管理可以挽救大部分患者。在那些预后因素较差的患者中，LT是唯一被证明能提高生存率的有效疗法。然而,识别预后差的合适患者仍然是一个挑战。密切监测,早期识别和治疗并发症，和表亲移植形成一线方法来管理这类患者。最近的研究表明，使用动态预后模型可以更好地选择肝移植患者，及时移植可以挽救预后不良因素的ALF患者的生命。
