Skip to main content

Acute Liver Failure in the ICU

  • Conference paper
Intensive Care Medicine
  • 331 Accesses

Abstract

Acute liver failure is a rare clinical syndrome resulting from severe hepatocyte injury, usually in the absence of pre-existing chronic liver disease. It is characterized by the onset of encephalopathy following the liver injury; jaundice is present in most patients but, in cases of hyperacute liver failure, encephalopathy may precede clinical jaundice. The prognosis in acute liver failure is variable, with mortality ranging from 10–90% without transplantation. The important factors determining outcome are principally: underlying etiology, age of the patient and time course over which the syndrome develops [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. O’Grady J (2000) Acute liver failure. In: O’Grady J, Lake J, Howdle P (eds) Comprehensive Clinical Hepatology, lst edn. Mosby, London, pp 30.1–30. 2

    Google Scholar 

  2. O’Grady JG, Schalm SW, Williams R (1993) Acute liver failure: redefining the syndromes. Lancet 342: 273–275

    Article  PubMed  Google Scholar 

  3. O’Grady JG, Alexander GJ, Hayllar KM, Williams R (1989) Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97: 439–445

    PubMed  Google Scholar 

  4. Shakil A, Kramer D, Mazariegos G, Fung J, Rakella J (2000) Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria. Liver Transplant 6: 163–169

    CAS  Google Scholar 

  5. Makin A, Wendon J, Williams R (1995) A 7 year experience of severe acetominophen-induced hepatotoxicity (1987–1993). Gastroenterology 109: 1907–1916

    Article  PubMed  CAS  Google Scholar 

  6. Mitchell I, Bihari D, Chang R, Wendon J, Williams R (1997) Earlier identification of patients at risk from acetominophen induced acute liver failure. Crit Care Med 26: 279–284

    Article  Google Scholar 

  7. Bernal W, Wendon J, Rela M, Heaton N, Williams R (1998) Use and outcome of liver transplantation in acetominophen induced acute liver failure. Hepatology 27: 1050–1055

    Article  PubMed  CAS  Google Scholar 

  8. Bernal W, Donaldson N, Wyncoll D, Wendon J (2002) Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet 358: 558–563

    Article  Google Scholar 

  9. Lerut J, Ciccarelli O, Roggen F, et al (2000) Progress in adult liver transplantation for acute liver failure. Transplantation Proc 32: 2704–2706

    Article  CAS  Google Scholar 

  10. Chenard-Neu MP, Boudjema K, Bernau J, et al (1996) Auxiliary liver transplantation: regeneration of the native liver and outcome in 30 patients with fulminant hepatic failure. A multicentre European study. Hepatology 23: 1119–1127

    Google Scholar 

  11. Blei A, Larsen F (1999) Pathophysiology of cerebral edema in fulminant hepatic failure. J Hepatol 31: 771–776

    Article  PubMed  CAS  Google Scholar 

  12. Traber P, DalCanto M, Ganger D, Blei AT (1989) Effect of body temperature on brain edema and encephalopathy in the rat after hepatic devascularisation. Gastroenterology 96: 885–891

    PubMed  CAS  Google Scholar 

  13. Marion DW, Penrod LE, Kelsey SF, et al (1997) Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 336: 540–546

    Article  PubMed  CAS  Google Scholar 

  14. Busto R, Dietrich WD, Globus MYT, Valdes I, Scheinberg P, Ginsberg MD (1987) Small differences in intra-ischaemic brain temperature critically determine the extent of ischaemic neuronal injury. J Cereb Blood Flow Metab 7: 729–738

    Article  PubMed  CAS  Google Scholar 

  15. Rose C, Michalak A, Pannuzio M, Chatauret N, Rambaldi A, Butterworth R (2000) Mild hypothermia delays the onset of coma and prevents brain edema and extracellular brain glutamate accumulation in rats with acute liver failure. Hepatology 31: 872–877

    Article  PubMed  CAS  Google Scholar 

  16. Vogels BAPM, Mass MAW, Daalhuisen J, Quack G, Chamuleau RAFM (1997) Memantine, a non-competitive NMDA-receptor antagonist improves hyperammonia-induced encephalopathy and acute hepatic encephalopathy in rats. Hepatology 25: 820–827

    Article  PubMed  CAS  Google Scholar 

  17. Keays RT, Alexander GJM, Williams R (1993) The safety and value of extradural intracranial pressure monitors in fulminant hepatic failure. J Hepatol 18: 205–209

    Article  PubMed  CAS  Google Scholar 

  18. Blei AT, Olafsson S, Webster S, Levy R (1993) Complications of intracranial pressure monitoring in fulminant hepatic failure. Lancet 34: 690–691

    Google Scholar 

  19. Kudo M (2001) Cerebral vascular resistance in hepatic insufficiency. J Gastroenterol Hepatol 16: 845–847

    Article  PubMed  CAS  Google Scholar 

  20. Srauss GI, Moller K, Holm S, Sperling B, Knudsen GM, Larsen FS (2001) Transcranial Doppler sonography and internal jugular bulb saturation during hyperventilation in patients with fulminant hepatic failure. Liver Transpl 7: 352–358

    Article  Google Scholar 

  21. Helme K, Burdelski M, Hansen HC (2000) Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation 70: 392–395

    Article  Google Scholar 

  22. Donovan JP, Shaw BW Jr, Langnas AN, Sorrell MF (1992) Brain water and acute liver failure: the emerging role of intracranial pressure monitoring. Hepatology 16: 267–268

    Article  PubMed  CAS  Google Scholar 

  23. Lucey MR, Brown KA, Everson GT, et al (1997) Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg 3: 628–637

    Article  PubMed  CAS  Google Scholar 

  24. Davies MH, Mutimer D, Lowes J, Elias E, Neuberger J (1994) Recovery despite impaired cerebral perfusion in fulminant hepatic failure. Lancet 343: 1329–1330

    Article  PubMed  CAS  Google Scholar 

  25. Davenport A, Will EJ, Davison AM (1990) Effect of posture on intracranial pressure and cerebral perfusion pressure in patients with fulminant hepatic failure and renal failure after acetominophen self-poisoning. Crit Care Med 18: 286–289

    Article  PubMed  CAS  Google Scholar 

  26. Hanid MA, Davies M, Mellon PJ, et al (1980) Clinical monitoring of intracranial pressure in fulminant hepatic failure. Gut 21: 866–869

    Article  PubMed  CAS  Google Scholar 

  27. Inoue S, Ninaga H, Kawaguchi M, Furuya H (1998) A case of shock subsequent to treatment of intracranial hypertension by mannitol injection combined with hyperventilation. J Neurosurg Anesthesiol 10: 113–115

    Article  PubMed  CAS  Google Scholar 

  28. Nau R (2000) Osmotherapy for elevated intracranial pressure: a critical reappraisal. Clin Pharmacokinet 38: 23–40

    Article  PubMed  CAS  Google Scholar 

  29. Kelly DF, Goodale DB, Williams J, et al (1999) Propofol in the treatment of moderate and severe head injury: a randomised, prospective double-blinded pilot trial. J Neurosurg 90: 1042–1052

    Article  PubMed  CAS  Google Scholar 

  30. Sakai K, Cho S, Fukusaki M, Shibata M, Sumikawa K (2000) The effects of Propofol with and without Ketamine on human cerebral blood flow velocity and CO2 response. Anesth Analg 90: 377–382

    PubMed  CAS  Google Scholar 

  31. Horn P, Munch E, Vajkoczy P, et al (1999) Hypertonic saline solution for control of elevated pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res 21: 758–764

    PubMed  CAS  Google Scholar 

  32. Strauss G, Hansen BA, Knudsen GM, Larsen FS (1998) Hyperventilation restores cerebral blood flow autoregulation in patients with acute liver failure. J Hepatol 28: 199–203

    Article  PubMed  CAS  Google Scholar 

  33. Wendon JA, Harrison PM, Keays R, Williams R (1994) Cerebral blood flow and metabolism in fulminant liver failure. Hepatology 19: 1407–1013

    Article  PubMed  CAS  Google Scholar 

  34. Larsen FS, Knudsen GM, Hansen BA (1997) Pathophysiological changes in cerebral circulation, oxidative metabolism and blood-brain barrier in patients with cute liver failure. J Hepatol 27: 231–238

    Article  PubMed  CAS  Google Scholar 

  35. Jalan R, Damink S, Deutz N, Lee A, Hayes P (1999) Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure. Lancet 354: 1164–1168

    Article  PubMed  CAS  Google Scholar 

  36. Harrigan MR, Tuteja S, Neudeck BL (1997) Indomethacin in the management of elevated intracranial pressure: a review. J Neurotrauma 14: 637–650

    Article  PubMed  CAS  Google Scholar 

  37. Markus HS, Vallance P, Brown MM (1994) Differential effect of three cyclooxygenase inhibitors on human cerebral blood flow velocity and carbon dioxide reactivity. Stroke 25: 1760–1764

    Article  PubMed  CAS  Google Scholar 

  38. Jensen K, Ohrstrm J, Cold GE, Astrup J (1991) The effects of indomethacin on intracranial pressure, cerebral blood flow and cerebral metabolism in patients with severe head injury and intracranial hypertension. Acta Neurochir 108: 116–121

    Article  PubMed  CAS  Google Scholar 

  39. Clemmesen JO, Hansen BA, Larsen FS (1997) Indomethacin normalizes intracranial pressure in acute liver failure: a twenty-three-year-old woman treated with indomethacin. Hepatology 26: 1423–1425

    Article  PubMed  CAS  Google Scholar 

  40. Rozga J, Podesta L, LePage E, et al (1993) Control of cerebral edema by total hepatectomy and extracorporeal liver support in fulminant hepatic failure. Lancet 342: 898–899

    Article  PubMed  CAS  Google Scholar 

  41. Jalan R, Pollok A, Shah S, Madhaven K, Simpson K (2002) Liver derived pro-inflammatory cytokines may be important in producing intracranial hypertension in acute liver failure. J Hepatol 73: 536–538

    Article  Google Scholar 

  42. Rolando N, Philpott-Howard J, Williams R (1996) Bacterial and fungal infection in acute liver failure. Semin Liver Dis 16: 389–402

    Article  PubMed  CAS  Google Scholar 

  43. Rolando N, Wade J, Davalos M, Wendon J, Philpott-Howard J, Williams R (2000) The systemic inflammatory response syndrome in acute liver failure. Hepatology 32: 734–739

    Article  PubMed  CAS  Google Scholar 

  44. Takada Y, Ishiguro S, Fukunaga K, et al (2001) Increased intracranial pressure in a porcine model of fulminant hepatic failure using amatoxin and endotoxin. J Hepatol 6:825–831 45 Moore K (1999) Renal failure in acute liver failure. Eur J Gastroenterol Hepatol 11: 967–975

    Google Scholar 

  45. Moore K, Wendon J, Frazer M, Karani J, Williams R, Badr K (1992) Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome. N Engl J Med 327: 17741778

    Google Scholar 

  46. Davenport A, Will EJ, Davison AM (1991) Continuous vs intermittent forms of haemofiltration and/or dialysis in the management of acute renal failure in patients with defective cerebral autoregulation at risk of cerebral oedema. Contrib Nephrol 93: 225–233

    PubMed  CAS  Google Scholar 

  47. Cole 1, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P (2001) High-volume haemofiltration in human septic shock. Intensive Care Med 27: 978–986

    Article  PubMed  CAS  Google Scholar 

  48. Clemmesen JE, Kondrop J, Nielsen LB, Larsen FS, Ott P (2001) Effects of high-volume plasmapharesis on ammonia, urea, and amino acids in patients with acute liver failure. Am J Gastroenterol 96: 1217–1223

    Article  PubMed  CAS  Google Scholar 

  49. Ho DWY, Fan ST, To J, et al (2002) Selective plasma filtration for treatment of fulminant hepatic failure induced by D-galactosamine in a pig model. Gut 50: 869–876

    Article  PubMed  CAS  Google Scholar 

  50. Murphy ND, Kodakat SK, Wendon J, et al (2001) Liver and Intestinal lactate metabolism in patients with acute hepatic failure undergoing liver transplantation. Crit Care Med 29: 2111–2118

    Article  PubMed  CAS  Google Scholar 

  51. Leifeld L, Fielenbach M, Dumoulin FL, Speidel N, Saauerbruch T, Spengler U (2002) Inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) expression in fulminant hepatic failure J Hepatol 37: 613–619

    CAS  Google Scholar 

  52. Harry R, Auzinger G, Wendon J (2002) The clinical importance of adrenal insufficiency in acute hepatic dysfunction. Hepatology 36: 395–402

    Article  PubMed  CAS  Google Scholar 

  53. Van den Berghe G, Wouters P, Weekers F, et al (2001) Intensive insulin therapy in the critically ill patient. N Engl J Med 345: 1359–1367

    Article  PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Sizer, E., Wendon, J., Bernal, W. (2003). Acute Liver Failure in the ICU. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-5548-0_78

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-5548-0_78

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-5550-3

  • Online ISBN: 978-1-4757-5548-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics