Worldwide differences in acute liver failure

Abstract

Acute liver failure (ALF) is a rare, potentially fatal complication of severe hepatic illness resulting from various causes. In a clinical setting, severe hepatic injury is usually recognized by the appearance of jaundice, encephalopathy and coagulopathy, although occasionally jaundice may even be absent in the earliest stages. ALF has been identified as a distinct clinical entity across the globe. Considerable geographical and regional differences exist in defining characteristics, etiologies and prognostic markers of ALF. A recent systematic review that evaluated 1233 published articles on ALF reported 41 different definitions with varying diagnostic characteristics to define ALF [1]. However, certain clinical characteristics in all these definitions are universal, such as absence of clinical evidence for pre-existing liver disease, presence of encephalopathy, and presence of coagulopathy. The major differences in defining ALF include the interval between onset of symptoms of acute liver injury and the occurrence of overt liver failure, defined by presence of encephalopathy and/or coagulopathy. Despite these differing definitions of ALF, the mortality reported in all reports is high and ranges from 60 to 80%. Differences in definition of ALF are related to its heterogeneous nature, which in part relates to ethnic and etiological differences prevalent in various geographical areas. Furthermore, in English literature, the term ‘fulminant hepatitis’ has been used in lieu of ‘ALF’ but, more recently, has been discarded