ABSTRACT
Clinical descriptions of fulminant hepatic failure as originally reported, along with
the subgroups of subfulminant and late onset hepatic failure identified later, are
considered in relation to the proposed new classification of hyperacute, acute, and
subacute liver failure. This reflects different clinical patterns of illness, etiology,
and most importantly, prognosis.
In addition to the defining state of encephalopathy and other manifestations directly
related to the severe derangement in function and structure of the liver, the constellation
of clinical symptoms and signs in acute liver failure (ALF) includes, to varying degrees,
those of multiorgan failure. The latter develops because of tissue hypoxia from microcirculatory
changes consequent on endotoxemia, and activation of macrophages and release of cytokines
as a result of secondary bacteria infection due to an early failure of host defenses
to infection in ALF.
Paracetamol overdose-the commonest cause of acute liver failure in the United Kingdom-is
increasing in frequency in other Western countries, but fulminant viral hepatitis
is the most frequent etiology worldwide. Marked geographical variations are seen in
the frequency with which the viral types A to E are implicated. Whereas hepatitis
C is the major cause of ALF in Japan and the Far East, fulminant hepatitis C is seen
rarely in America and European countries where most series show that in about one
third of cases of presumed viral ALF, no specific agent can be identified.
Over the past 10 years, the survival of those with grade 3 to 4 encephalopathy has
shown a steady rise as a result of improvements in medical care, quite apart from
the introduction and now widespread availability of transplantation for the treatment
of this condition. As shown by a number of groups, a variety of different hematologic,
biochemical, and clinical features can be used as predictive indices of the likely
outcome and in determining the approach to treatment.
KEY WORDS
Acute liver failure - fulminant viral hepatitis - drug hepatotoxicity
