Abstract：
OBJECTIVE: Acute liver failure (ALF) is a medical emergency and liver transplantation (LT) may be required as definitive therapy. The etiology varies across geographical locations and is mostly viral dominant in India. We aimed at evaluating the spectrum, impact of interventions (plasma exchange [PLEx], continuous renal replacement therapy [CRRT]) and outcomes of ALF in India in recent times.
METHODS: A multicentre retrospective study across four major tertiary care centres.
RESULTS: As many as 183 ALF patients (median age, 23 years; females, 43.1%; model for end-stage liver disease [MELD], 32.7) from January 2021 to December 2023 were included. Nineteen per cent had infection and 40.4% of patients satisfied King\'s College criteria (KCC) at admission. Most common cause for ALF was hepatitis A virus (HAV) (44.2%) followed by rodenticide poisoning (10.3%). Approximately 35% of patients each received either PLEx or CRRT. The 7, 14 and 21-day transplant-free survival probability was 65.5%, 60.1%, and 57.3%, respectively. Only 3.8% of patients underwent liver transplantation. On multivariable Cox regression analysis, hemoglobin (HR, 0.74 [0.63-0.87]), lactate (HR, 1.14 [1.03-1.26]), advanced hepatic encephalopathy (HE) (HR, 4.87 [1.89-12.5]) and fulfilling KCC [HR, 10.04 [4.57-22.06]) at admission were the independent predictors of mortality. A model including KCC + lactate + HE ≥ 3 with or without hemoglobin had an AUROC of 0.81-0.84 to predict mortality. In those who underwent PLEx, advanced HE (HR, 4.13 [1.75-9.7]), procalcitonin (HR, 1.18 [1.07-1.30]) and KCC (HR, 4.6 [1.6-13.1), while for those who received CRRT, lactate (HR, 1.37 [1.22-1.54]) and KCC (HR, 6.4 [2.5-15.8]) independently predicted mortality.
CONCLUSIONS: Hepatitis A virus is currently the most common cause for ALF in India, emphasizing the need for universal vaccination programmes. Spontaneous survival in tertiary care centres is 57%. LT rates were low.
METHODS: A multicentre retrospective study across four major tertiary care centres.
RESULTS: As many as 183 ALF patients (median age, 23 years; females, 43.1%; model for end-stage liver disease [MELD], 32.7) from January 2021 to December 2023 were included. Nineteen per cent had infection and 40.4% of patients satisfied King\'s College criteria (KCC) at admission. Most common cause for ALF was hepatitis A virus (HAV) (44.2%) followed by rodenticide poisoning (10.3%). Approximately 35% of patients each received either PLEx or CRRT. The 7, 14 and 21-day transplant-free survival probability was 65.5%, 60.1%, and 57.3%, respectively. Only 3.8% of patients underwent liver transplantation. On multivariable Cox regression analysis, hemoglobin (HR, 0.74 [0.63-0.87]), lactate (HR, 1.14 [1.03-1.26]), advanced hepatic encephalopathy (HE) (HR, 4.87 [1.89-12.5]) and fulfilling KCC [HR, 10.04 [4.57-22.06]) at admission were the independent predictors of mortality. A model including KCC + lactate + HE ≥ 3 with or without hemoglobin had an AUROC of 0.81-0.84 to predict mortality. In those who underwent PLEx, advanced HE (HR, 4.13 [1.75-9.7]), procalcitonin (HR, 1.18 [1.07-1.30]) and KCC (HR, 4.6 [1.6-13.1), while for those who received CRRT, lactate (HR, 1.37 [1.22-1.54]) and KCC (HR, 6.4 [2.5-15.8]) independently predicted mortality.
CONCLUSIONS: Hepatitis A virus is currently the most common cause for ALF in India, emphasizing the need for universal vaccination programmes. Spontaneous survival in tertiary care centres is 57%. LT rates were low.
摘要：
目的：急性肝衰竭（ALF）是一种医疗紧急情况，可能需要肝移植（LT）作为确定性治疗。病因因地理位置而异，在印度主要是病毒。我们的目标是评估光谱，干预措施的影响(血浆置换[PLEx]，连续肾脏替代疗法[CRRT]）和最近印度ALF的结果。
方法：一项跨四个主要三级护理中心的多中心回顾性研究。
结果：多达183例ALF患者（中位年龄，23岁；女性，43.1%；终末期肝病模型[MELD]，32.7）从2021年1月到2023年12月被包括在内。19％的患者感染，40.4％的患者在入院时符合国王学院标准（KCC）。ALF的最常见原因是甲型肝炎病毒（HAV）（44.2％），其次是杀鼠剂中毒（10.3％）。大约35%的患者接受PLEx或CRRT。7、14和21天无移植存活概率为65.5%,60.1%,57.3%,分别。只有3.8％的患者接受了肝移植。关于多变量Cox回归分析，血红蛋白（HR，0.74[0.63-0.87]),乳酸（HR，1.14[1.03-1.26]),晚期肝性脑病（HE）（HR，4.87[1.89-12.5])并履行KCC[人力资源，入院时10.04[4.57-22.06]）是死亡率的独立预测因子。包括有或没有血红蛋白的KCC+乳酸+HE≥3的模型具有0.81-0.84的AUROC来预测死亡率。在那些接受PLEx的人中，高级HE(HR，4.13[1.75-9.7]),降钙素原（HR，1.18[1.07-1.30])和KCC(HR，4.6[1.6-13.1),而对于那些接受CRRT的人来说，乳酸（HR，1.37[1.22-1.54])和KCC(HR，6.4[2.5-15.8])独立预测死亡率。
结论：目前，甲型肝炎病毒是印度ALF的最常见原因，强调普遍疫苗接种计划的必要性。三级护理中心的自发生存率为57％。LT率很低。
方法：一项跨四个主要三级护理中心的多中心回顾性研究。
结果：多达183例ALF患者（中位年龄，23岁；女性，43.1%；终末期肝病模型[MELD]，32.7）从2021年1月到2023年12月被包括在内。19％的患者感染，40.4％的患者在入院时符合国王学院标准（KCC）。ALF的最常见原因是甲型肝炎病毒（HAV）（44.2％），其次是杀鼠剂中毒（10.3％）。大约35%的患者接受PLEx或CRRT。7、14和21天无移植存活概率为65.5%,60.1%,57.3%,分别。只有3.8％的患者接受了肝移植。关于多变量Cox回归分析，血红蛋白（HR，0.74[0.63-0.87]),乳酸（HR，1.14[1.03-1.26]),晚期肝性脑病（HE）（HR，4.87[1.89-12.5])并履行KCC[人力资源，入院时10.04[4.57-22.06]）是死亡率的独立预测因子。包括有或没有血红蛋白的KCC+乳酸+HE≥3的模型具有0.81-0.84的AUROC来预测死亡率。在那些接受PLEx的人中，高级HE(HR，4.13[1.75-9.7]),降钙素原（HR，1.18[1.07-1.30])和KCC(HR，4.6[1.6-13.1),而对于那些接受CRRT的人来说，乳酸（HR，1.37[1.22-1.54])和KCC(HR，6.4[2.5-15.8])独立预测死亡率。
结论：目前，甲型肝炎病毒是印度ALF的最常见原因，强调普遍疫苗接种计划的必要性。三级护理中心的自发生存率为57％。LT率很低。
