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Cited by 844Liver Disease and TransplantationDrug-Induced Hepatotoxicity and ProtectionLiver Disease Diagnosis and Treatment

Acute liver failure

Open access
Stravitz, R Todd, Lee, William M·2019·The Lancet
DOI 10.1016/s0140-6736(19)31894-xPMC PMC10836844
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Abstract

Acute liver failure is a rare and severe consequence of abrupt hepatocyte injury, and can evolve over days or weeks to a lethal outcome. A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of aminotransferases, altered mentation, and disturbed coagulation. The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure. Causes of acute liver failure include paracetamol toxicity, hepatic ischaemia, viral and autoimmune hepatitis, and drug-induced liver injury from prescription drugs, and herbal and dietary supplements. Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomised trials, and most treatment recommendations represent expert opinion. Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.

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Crossref · 10.1016/s0140-6736(19)31894-x

Cites

135 of 135 references verified0 citation errors · 0 not checkable

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  • In acute liver failure, the liver's regenerative capacity is often overwhelmed, leaving emergency liver transplantation as the only curative option.

    “however, in the setting of acute liver failure (ALF), this regenerative capacity is often overwhelmed, leaving emergency liver transplantation as the only curative option3–5”

    From Multimodal decoding of human liver regeneration (2024) · cites this paper as [3]

    The Pathogenesis section says failure of regeneration is an important feature of acute liver failure for at least some causes, and the Liver transplantation section describes transplantation as life-saving. But the Outcomes section reports that many patients recover with their native liver—about 75% after paracetamol-induced failure and 40% after other causes—so the paper does not support transplantation as the only curative option for acute liver failure generally. Page numbers were not available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • APAP toxicity is the most common cause of ALF in the UK (65.4% of cases) and the USA (45.7%).

    “with APAP toxicity representing the most common cause in the UK (65.4% of cases) and the USA (45.7%)3”

    From Multimodal decoding of human liver regeneration (2024) · cites this paper as [3]

    The Paracetamol section identifies paracetamol (APAP) toxicity as the most commonly observed cause of acute liver failure in developed countries and gives 65.4% for the UK. It gives 45.7% for cases recorded in North America, not specifically the USA, so the US-specific figure is not fully supported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Expeditious wound closure in the liver with restoration of the gut-liver barrier following acute, massive epithelial injury may be a key determinant of patient outcome in ALF.

    “Expeditious wound closure in the liver, with restoration of the gut–liver barrier following acute, massive epithelial injury, may be a key determinant of patient outcome in ALF in which sepsis and multi-organ failure are the most common cause of death3–5.”

    From Multimodal decoding of human liver regeneration (2024) · cites this paper as [3]

    The Management of systemic complications section (page unavailable) says systemic complications are the most common cause of death in acute liver failure and that infection often triggers multisystem organ failure. It does not identify sepsis specifically as a most common cause of death. The wound-closure proposal is the citing authors’ framing, not a finding attributed to this source. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • ALF is a syndrome of severe liver injury in the absence of chronic liver disease.

    “ALF is a syndrome of severe liver injury in the absence of chronic liver disease3–5”

    From Multimodal decoding of human liver regeneration (2024) · cites this paper as [3]

  • ALF often affects previously healthy individuals, has a rapid onset, and has a frequently fatal outcome (30% mortality).

    “ALF is often unexpected, affecting previously healthy individuals, and has a rapid onset with a frequently fatal outcome (30% mortality)3”

    From Multimodal decoding of human liver regeneration (2024) · cites this paper as [3]

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Cites

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Research works printed but not linked: 1

  1. [120]Bernuau J, Samuel D, Durand F. Criteria for emergency liver transplantation in patients with acute viral hepatitis and factor V below 50% of normal: a prospective study. Hepatology 1991; 14: 49A (abstr).

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Authors
Stravitz, R. T., & Lee, W. M.
Affiliations
  • Virginia Commonwealth University (US)
  • The University of Texas Southwestern Medical Center (US)
Corresponding author
Lee, William M
ORCID
Lee, William M
Venue
The Lancet
Publisher
Elsevier BV
Published
2019-09
Volume
394
Issue
10201
Pages
869-881
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(19)31894-x
PMC
PMC10836844
OpenAlex
W4211175126
Cited by
844
References
135
Citations by year
2026: 85 · 2025: 141 · 2024: 188 · 2023: 133 · 2022: 129 · 2021: 101 · 2020: 63 · 2019: 2 · 2015: 1
FWCI
9.62
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Bristol-Myers Squibb
  • Sanofi
  • University of South Carolina
  • Mallinckrodt Pharmaceuticals
  • Southwestern Medical Foundation
  • Novo Nordisk
  • U.S. Food and Drug Administration
  • Genentech
  • National Cancer Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058369, U01DK058369)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Keywords
acute liver failure, hepatocyte injury, aminotransferase elevation, altered mental status, coagulopathy, acetaminophen toxicity, hepatic ischemia, viral hepatitis, autoimmune hepatitis, drug-induced liver injury, liver transplantation, mortality
MeSH terms
Acetaminophen, Adult, Female, Humans, Male, Middle Aged, Liver Transplantation, Chemical and Drug Induced Liver Injury, Chronic, Acute-On-Chronic Liver Failure

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