Common causes of acute liver failure in a monocenter study: Potential significant reduction of mortality by timely HBV/HAV vaccination

Aims: Acute liver failure (ALF) is the final common pathway of severe hepatocyte injury, with coagulopathy, onset of hepatic encephalopathy within eight weeks from the initial symptoms and a high correlative rate of mortality. AIM: To determine the causes of ALF in our center over a one-year period. Methods: A retrospective monocenter 1-year study (2004) enrolled 31 patients (71% females / 29% males; 42.7±11.6 years of age) fulfilling established criteria for ALF. Causes of liver failure included drug toxicity (41.94%), viral hepatitis (29.03%), autoimmune hepatitis (9.68%), and miscellaneous (19.35%). All patient histories were thoroughly reviewed. Throughout the course of the study, patients were monitored for established clinical signs and laboratory parameters of acute liver injury. Results: Drug toxicity as a cause of ALF (n=13) included Marcumar (3), acetaminophen (3), and oral contraceptives (2). Causative viral hepatitis (n=9) was either due to HBV (5), HAV (2), HSV (1), or EBV (1). Three patients suffered from autoimmune hepatitis, three patients (9.68%) received an orthotopic liver allograft, and three patients (9.68%) deceased over the course of the study. Conclusions: These data confirm our previous results of drug toxicity as the most prevalent cause of ALF in this center. However, because viral hepatitis – as etiologically mainly related to HBV and HAV – was found causative for ALF in 22.58% of all patients, HBV/ HAV vaccination promises to save considerable numbers of patients from liver damage and consecutive organ failure.

Drug toxicity - Viral hepatitis