Viral Hepatitis-Related Acute Liver Failure is not Associated With Long-Term Complications

Abstract

Background and Aim: The long-term outcomes of survivors of viral hepatitis-related acute liver failure (ALF) are not known. The aim was to evaluate the long-term outcomes and liver-related morbidities in viral hepatitis-related ALF. Methods: In this retrospective study, all survivors of viral hepatitis-related ALF evaluated at a tertiary care center in India were included. Baseline demographic profile, laboratory data, and etiology were collected from the prospectively maintained database. Patients were evaluated physically or contacted through either post or telephone for survival and complications. Results: A total of 1462 ALF patients were evaluated between January 1986 to December 2015. Of these 599 (41.0%) survived spontaneously; 190/599 (31.7%) were reevaluated, rest 409/599 (68.3%) were lost to follow-up. The mean ± sd duration of follow-up of 190 ALF survivors was 18.7 ± 26.8 months. Most of the survivors were young (median age 24 years) and 342 (57.1%) were females. Among these survivors, advanced grades of encephalopathy were present in 369/563 (65.5%) and cerebral edema in 176/578 (30.4%). Renal failure, gastrointestinal bleeding, and seizures were seen infrequently in 11.4%, 2.9%, and 2.8%, respectively. The commonest etiology was hepatitis E virus (HEV) followed by cryptogenic causes. None of the patients had an underlying history of alcohol or any other drug abuse (apart from antituberculosis therapy in 31 ALF patients), and psychiatric disorder requiring medications. None of the ALF survivors had died or developed liver-related or neurological morbidity on follow-up. Conclusion: Spontaneous survivors of viral hepatitis-related acute liver failure have a good long term outcome. Liver-related and neurological morbidity or mortality is not seen post recovery.