HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

HEPATIC FAILURES IN INTENSIVE CARE UNIT

Berkay Küçük

Ankara Etlik City Hospital, Department of Intensive Care, Ankara, Türkiye

Küçük B. Hepatic Failures in Intensive Care Unit. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.103-115.

ABSTRACT

Acute liver failure is a critical medical condition characterized by hepatic encephalopathy and coagulopathy in a patient with no previous liver disease and can lead to severe morbidity and mortality. Acute on chronic liver failure describes the decompensation of preexisting chronic liver disease due to various causes. Decompensation can rapidly progress to multiple organ failure in the absence of appropriate followup and treatment. Clinical course and prognosis vary according to the etiology of the disease and are also crucial in terms of treatment plans. Depending on the etiology, antivirals, antidotes, or removal of toxins from the body are at the forefront, while termination of pregnancy may be required in pregnant patients. Although liver failure is considered reversible, the prognosis is poor if left untreated. Therefore, supportive treatment is of critical importance, and management of organ dysfunctions and complications should be performed without delay under intensive care conditions. For patients who do not respond to treatment, it is vital to determine the need for transplantation and transfer to the appropriate center. Largescale studies with more patients are needed to develop artificial support and liver devices and assess their efficacy.

Keywords: Acute liver failure; Acetaminophen; Hepatic encephalopathy; Liver transplantation; Critical care

Referanslar

  1. Bernal W, Wendon J. Acute liver failure. N Engl J Med. 2013;369(26):2525-2534. [Crossref]  [PubMed]
  2. Horvatits T, Drolz A, Trauner M, Fuhrmann V. Liver Injury and Failure in Critical Illness. Hepatology. 2019;70(6):2204-2215. [Crossref]  [PubMed]
  3. Perez Ruiz de Garibay A, Kortgen A, Leonhardt J, Zipprich A, Bauer M. Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients. Crit Care. 2022;26(1):289. Published 2022 Sep 26. [Crossref]  [PubMed]  [PMC]
  4. Leão GS, Lunardi FL, Picon RV, Tovo CV, de Mattos AA, de Mattos ÂZ. Acute-on-chronic liver failure: A comparison of three different diagnostic criteria. Ann Hepatol. 2019;18(2):373-378. [Crossref]  [PubMed]
  5. O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes [published correction appears in Lancet 1993 Oct 16;342(8877):1000]. Lancet. 1993;342(8866):273-275. [Crossref]  [PubMed]
  6. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical practice guidelines panel, Wendon, J, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047-1081. [Crossref]  [PubMed]
  7. Stravitz RT, Sanyal AJ, Reisch J, Bajaj JS, Mirshahi F, Cheng J, Lee WM; Acute Liver Failure Study Group. Effects of N-acetylcysteine on cytokines in non-acetaminophen acute liver failure: potential mechanism of improvement in transplant-free survival. Liver Int. 2013 Oct;33(9):1324-31. Epub 2013 Jun 19. [Crossref]  [PubMed]  [PMC]
  8. Vento S, Cainelli F. Acute liver failure in low-income and middle-income countries. Lancet Gastroenterol Hepatol. 2023;8(11):1035-1045. [Crossref]  [PubMed]
  9. Nephew L, Zia Z, Ghabril M, Orman E, Lammert C, Chalasani N. Black Adult Patients With Acute Liver Failure Are Sicker and More Likely to Undergo Liver Transplantation Than White Patients. Liver Transpl. 2019;25(11):1634-1641. [Crossref]  [PubMed]
  10. Pathikonda M, Munoz SJ. Acute liver failure. Ann Hepatol. 2010;9(1):7-14. [Crossref]  [PubMed]
  11. Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, et al. Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure [published correction appears in J Clin Exp Hepatol. 2022 Mar-Apr;12(2):729-730. J Clin Exp Hepatol. 2020;10(5):477-517. [Crossref]  [PubMed]  [PMC]
  12. Brennan PN, Donnelly MC, Simpson KJ. Systematic review: non A-E, seronegative or indeterminate hepatitis; what is this deadly disease?. Aliment Pharmacol Ther. 2018;47(8):1079-1091. [Crossref]  [PubMed]
  13. Lee WM, Seremba E. Etiologies of acute liver failure. Curr Opin Crit Care. 2008;14(2):198-201. [Crossref]  [PubMed]
  14. Fernández J, Bassegoda O, Toapanta D, Bernal W. Acute liver failure: A practical update. JHEP Rep. 2024;6(9):101131. Published 2024 Jun 10. [Crossref]  [PubMed]  [PMC]
  15. Elazar M, Glenn JS. Emerging concepts for the treatment of hepatitis delta. Curr Opin Virol. 2017;24:55-59. [Crossref]  [PubMed]
  16. Guvenir M, Arikan A. Hepatitis B Virus: From Diagnosis to Treatment. Pol J Microbiol. 2020;69(4):391-399. [Crossref]  [PubMed]  [PMC]
  17. Chen EQ, Zeng F, Zhou LY, Tang H. Early warning and clinical outcome prediction of acute-on-chronic hepatitis B liver failure. World J Gastroenterol. 2015;21(42):11964-11973. [Crossref]  [PubMed]  [PMC]
  18. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018;68(6):1256-1271. [Crossref]  [PubMed]
  19. Shingina A, Mukhtar N, Wakim-Fleming J, Alqahtani S, Wong RJ, Limketkai BN, et al. Acute Liver Failure Guidelines. Am J Gastroenterol. 2023;118(7):1128-1153. [Crossref]  [PubMed]
  20. Allison R, Guraka A, Shawa IT, Tripathi G, Moritz W, Kermanizadeh A. Drug induced liver injury - a 2023 update. J Toxicol Environ Health B Crit Rev. 2023;26(8):442-467. [Crossref]  [PubMed]
  21. Hassan A, Fontana RJ. The diagnosis and management of idiosyncratic drug-induced liver injury. Liver Int. 2019;39(1):31-41. [Crossref]  [PubMed]
  22. Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI, Lee W, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023;77(3):1036-1065. [Crossref]  [PubMed]  [PMC]
  23. Ichai P, Laurent-Bellue A, Saliba F, Moreau D, Besch C, Francoz C, et al. Acute Liver Failure/Injury Related to Drug Reaction With Eosinophilia and Systemic Symptoms: Outcomes and Prognostic Factors. Transplantation. 2017;101(8):1830-1837. [Crossref]  [PubMed]
  24. Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol. 2023;19(5):297-317. [Crossref]  [PubMed]
  25. Chiew AL, Gluud C, Brok J, Buckley NA. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018;2(2):CD003328. Published 2018 Feb 23. [Crossref]  [PubMed]  [PMC]
  26. Kayes T, Ho V. Amanita phalloides-Associated Liver Failure: Molecular Mechanisms and Management. Int J Mol Sci. 2024;25(23):13028. Published 2024 Dec 4. [Crossref]  [PubMed]  [PMC]
  27. Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences. Geburtshilfe Frauenheilkd. 2020;80(5):499-507. [Crossref]  [PubMed]  [PMC]
  28. Privitera G, Agarwal B, Jalan R. Acute liver failure: pathophysiologic basis, and the current and emerging therapies. EMJ Hepatol. 2014;1[1]:99-107. [Crossref]
  29. Amin AA, Agarwal B, Jalan R. Acute liver failure: updates in pathogenesis and management. Medicine 2019; 47: 838e42 (Baltimore). [Crossref]
  30. Ferenci P. Hepatic encephalopathy. Gastroenterol Rep (Oxf). 2017;5(2):138-147. [Crossref]  [PubMed]  [PMC]
  31. Sheikh MF, Unni N, Agarwal B. Neurological Monitoring in Acute Liver Failure. J Clin Exp Hepatol. 2018;8(4):441-447. [Crossref]  [PubMed]  [PMC]
  32. Scott TR, Kronsten VT, Hughes RD, Shawcross DL. Pathophysiology of cerebral oedema in acute liver failure. World J Gastroenterol. 2013;19(48):9240-9255. [Crossref]  [PubMed]  [PMC]
  33. Bjerring PN, Eefsen M, Hansen BA, Larsen FS. The brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema. Metab Brain Dis. 2009;24(1):5-14. [Crossref]  [PubMed]
  34. Slack AJ, Auzinger G, Willars C, Dew T, Musto R, Corsilli D, et al. Ammonia clearance with haemofiltration in adults with liver disease. Liver Int. 2014;34(1):42-48. [Crossref]  [PubMed]
  35. Halstead MR, Geocadin RG. The Medical Management of Cerebral Edema: Past, Present, and Future Therapies. Neurotherapeutics. 2019;16(4):1133-1148. [Crossref]  [PubMed]  [PMC]
  36. Aziz R, Price J, Agarwal B. Management of acute liver failure in intensive care. BJA Educ. 2021;21(3):110-116. [Crossref]  [PubMed]  [PMC]
  37. Van Eldere A, Pirani T. Liver intensive care for the general intensivist. Anaesthesia. 2023;78(7):884-901. [Crossref]  [PubMed]
  38. Del Risco-Zevallos J, Andújar AM, Piñeiro G, Reverter E, Toapanta ND, Sanz M, et al. Management of acute renal replacement therapy in critically ill cirrhotic patients. Clin Kidney J. 2022;15(6):1060-1070. Published 2022 Jan28. [Crossref]  [PubMed]  [PMC]
  39. Wong F, Piano S, Singh V, Bartoletti M, Maiwall R, Alessandria C, et al. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure. J Hepatol. 2021;74(2):330-339. [Crossref]  [PubMed]
  40. Ozturk NB, Herdan E, Saner FH, Gurakar A. A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure. J Clin Med. 2023;12(23):7451. Published 2023 Nov 30. [Crossref]  [PubMed]  [PMC]
  41. Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019;38(2):485-521. [Crossref]  [PubMed]  [PMC]
  42. Tujios S, Stravitz RT, Lee WM. Management of Acute Liver Failure: Update 2022. Semin Liver Dis. 2022;42(3):362-378. [Crossref]  [PubMed]  [PMC]
  43. Popescu M, David C, Marcu A, Olita MR, Mihaila M, Tomescu D. Artificial Liver Support with CytoSorb and MARS in Liver Failure: A Retrospective Propensity Matched Analysis. J Clin Med. 2023;12(6):2258. Published 2023 Mar 14. [Crossref]  [PubMed]  [PMC]
  44. Olivo R, Guarrera JV, Pyrsopoulos NT. Liver Transplantation for Acute Liver Failure. Clin Liver Dis. 2018;22(2):409-417. [Crossref]  [PubMed]