Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Robert J Fontana; Caitlyn Ellerbe; Valerie E Durkalski; Amol Rangnekar; Rajender K Reddy; Todd Stravitz; Brendan McGuire; Timothy Davern; Adrian Reuben; Iris Liou; Oren Fix; Daniel R Ganger; Raymond T Chung; Mike Schilsky; Steven Han; Linda S Hynan; Corron Sanders; William M Lee; US Acute Liver Failure Study Group; Frank Vinholt Schiødt

doi:10.1111/liv.12632

Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Robert J Fontana, Caitlyn Ellerbe, Valerie E Durkalski, Amol Rangnekar, Rajender K Reddy, Todd Stravitz, Brendan McGuire, Timothy Davern, Adrian Reuben, Iris Liou, Oren Fix, Daniel R Ganger, Raymond T Chung, Mike Schilsky, Steven Han, Linda S Hynan, Corron Sanders, William M Lee, US Acute Liver Failure Study Group, Frank Vinholt Schiødt

Digestive Diease Center BFH

54 Citations (Scopus)

Abstract

BACKGROUND & AIMS: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).

METHODS: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.

RESULTS: Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).

CONCLUSIONS: Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

Original language	English
Journal	Liver international : official journal of the International Association for the Study of the Liver
Volume	35
Issue number	2
Pages (from-to)	370-80
Number of pages	11
ISSN	1478-3223
DOIs	https://doi.org/10.1111/liv.12632
Publication status	Published - Feb 2015

Keywords

Acetaminophen
Adult
Female
Follow-Up Studies
Humans
Liver Failure, Acute
Liver Transplantation
Male
Middle Aged
Prospective Studies
Statistics, Nonparametric
Survivors
Transplant Recipients
Treatment Outcome

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10.1111/liv.12632

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Fontana, R. J., Ellerbe, C., Durkalski, V. E., Rangnekar, A., Reddy, R. K., Stravitz, T., McGuire, B., Davern, T., Reuben, A., Liou, I., Fix, O., Ganger, D. R., Chung, R. T., Schilsky, M., Han, S., Hynan, L. S., Sanders, C., Lee, W. M., US Acute Liver Failure Study Group, & Schiødt, F. V. (2015). Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study. Liver international : official journal of the International Association for the Study of the Liver, 35(2), 370-80. https://doi.org/10.1111/liv.12632

Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study. / Fontana, Robert J; Ellerbe, Caitlyn; Durkalski, Valerie E et al.
In: Liver international : official journal of the International Association for the Study of the Liver, Vol. 35, No. 2, 02.2015, p. 370-80.

Research output: Contribution to journal › Journal article › Research › peer-review

Fontana, RJ, Ellerbe, C, Durkalski, VE, Rangnekar, A, Reddy, RK, Stravitz, T, McGuire, B, Davern, T, Reuben, A, Liou, I, Fix, O, Ganger, DR, Chung, RT, Schilsky, M, Han, S, Hynan, LS, Sanders, C, Lee, WM, US Acute Liver Failure Study Group & Schiødt, FV 2015, 'Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study', Liver international : official journal of the International Association for the Study of the Liver, vol. 35, no. 2, pp. 370-80. https://doi.org/10.1111/liv.12632

@article{80731e8230d3463c913fe92c35362d33,

title = "Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study",

abstract = "BACKGROUND & AIMS: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).METHODS: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.RESULTS: Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).CONCLUSIONS: Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.",

keywords = "Acetaminophen, Adult, Female, Follow-Up Studies, Humans, Liver Failure, Acute, Liver Transplantation, Male, Middle Aged, Prospective Studies, Statistics, Nonparametric, Survivors, Transplant Recipients, Treatment Outcome",

author = "Fontana, {Robert J} and Caitlyn Ellerbe and Durkalski, {Valerie E} and Amol Rangnekar and Reddy, {Rajender K} and Todd Stravitz and Brendan McGuire and Timothy Davern and Adrian Reuben and Iris Liou and Oren Fix and Ganger, {Daniel R} and Chung, {Raymond T} and Mike Schilsky and Steven Han and Hynan, {Linda S} and Corron Sanders and Lee, {William M} and {US Acute Liver Failure Study Group} and Schi{\o}dt, {Frank Vinholt}",

note = "{\textcopyright} 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2015",

month = feb,

doi = "10.1111/liv.12632",

language = "English",

volume = "35",

pages = "370--80",

journal = "Liver international : official journal of the International Association for the Study of the Liver",

issn = "1478-3223",

publisher = "Wiley-Blackwell Munksgaard",

number = "2",

}

TY - JOUR

T1 - Two-year outcomes in initial survivors with acute liver failure

T2 - results from a prospective, multicentre study

AU - Fontana, Robert J

AU - Ellerbe, Caitlyn

AU - Durkalski, Valerie E

AU - Rangnekar, Amol

AU - Reddy, Rajender K

AU - Stravitz, Todd

AU - McGuire, Brendan

AU - Davern, Timothy

AU - Reuben, Adrian

AU - Liou, Iris

AU - Fix, Oren

AU - Ganger, Daniel R

AU - Chung, Raymond T

AU - Schilsky, Mike

AU - Han, Steven

AU - Hynan, Linda S

AU - Sanders, Corron

AU - Lee, William M

AU - US Acute Liver Failure Study Group

AU - Schiødt, Frank Vinholt

PY - 2015/2

Y1 - 2015/2

N2 - BACKGROUND & AIMS: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).METHODS: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.RESULTS: Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).CONCLUSIONS: Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

AB - BACKGROUND & AIMS: The long-term clinical outcomes in initial survivors with acute liver failure (ALF) are not well known. The aim of this study was to provide an overview of the 2-year clinical outcomes among initial survivors and liver transplant (LT) recipients that were alive 3 weeks after enrolment in the Acute Liver Failure Study Group (ALFSG).METHODS: Outcomes in adult ALFSG patients that were enrolled between 1998 and 2010 were reviewed.RESULTS: Two-year patient survival was significantly higher in the 262 LT recipients (92.4%) compared to the 306 acetaminophen (APAP) spontaneous survivors (SS) (89.5%) and 200 non-APAP SS (75.5%) (P < 0.0001). The causes of death were similar in the three groups but the time to death was significantly longer in the LT recipients (P < 0.0001). Independent predictors of 2-year mortality in the APAP group were a high serum phosphate level and patient age (c-statistic = 0.65 (0.54, 0.76)), patient age and days from jaundice to ALF onset in the non-APAP group (c-statistic = 0.69 (0.60, 0.78)), and patient age, days from jaundice, and higher coma grade in the LT recipients (c-statistic = 0.74 (0.61, 0.87)). The LT recipients were significantly more likely to be employed and have a higher educational level (P < 0.05).CONCLUSIONS: Two-year outcomes in initial survivors of ALF are generally good but non-APAP patients have a significantly lower survival which may relate to pre-existing medical comorbidities. Spontaneous survivors with APAP overdose experience substantial morbidity during follow-up from ongoing psychiatric and substance abuse issues.

KW - Acetaminophen

KW - Adult

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Liver Failure, Acute

KW - Liver Transplantation

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Statistics, Nonparametric

KW - Survivors

KW - Transplant Recipients

KW - Treatment Outcome

U2 - 10.1111/liv.12632

DO - 10.1111/liv.12632

M3 - Journal article

C2 - 25039930

SN - 1478-3223

VL - 35

SP - 370

EP - 380

JO - Liver international : official journal of the International Association for the Study of the Liver

JF - Liver international : official journal of the International Association for the Study of the Liver

IS - 2

ER -

Two-year outcomes in initial survivors with acute liver failure: results from a prospective, multicentre study

Abstract

Keywords

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