Hepatik Yetmezlik
Özet
Akut karaciğer yetmezliği, akut karaciğer hasarı, hepatik ensefalopati ve artmış protrombin zamanı / uluslararası normalleştirilmiş oran(INR) ile karakterize olan, mortalitesi oldukça yüksek bir klinik durumdur.Bu nedenle Akut karaciğer yetmezlikli hastalar, mümkün olduğunca karaciğer nakli yapılabilen bir merkezde ve yoğun bakım ünitesinde takip edilmelidirler. ABD’de yılda 2000-2800 vaka görülmekte olup tüm ölümlerin %0,1’ini, karaciğere bağlı ölümlerin %6’ sını oluşturmaktadır. Karaciğer nakillerinin ise %5-6’sının akut karaciğer yetmezliğine bağlı olduğu saptanmıştır. İlerlemiş tıbbi tedavi ve acil organ nakli olanaklarına rağmen bu hastaların mortalitesi hala %50 civarındadır.
Viral ajanlar ve ilaca bağlı hepatitler, yetişkinlerde akut karaciğer yetmezliğinin en yaygın nedenleridir. Akut karaciğer yetmezliği, hepatik ensefalopati belirtileri ve uzamış protrombin zamanı (INR ≥1.5) ile birlikte karaciğer testi anormallikleri olan hastalarda ayırıcı tanıda yer almalıdır.
Bu hastalarda tedavi çoğunlukla destek tedavisi ve saptanabilirse etkene yönelik tedavi şeklinde olmalı ve bu hastalarda iyi bir yoğun bakım desteği yanında her an acil karaciğer nakli gerekebileceği için bu konuda yeterli ve deneyimli merkezlerde takip edilmelidir.
Acute liver failure is a clinical condition characterized by acute liver injury, hepatic encephalopathy, and increased prothrombin time/international normalized ratio (INR) with a high mortality rate. Therefore, patients with acute liver failure should be followed up in a liver transplantation center and intensive care unit whenever possible. There are 2000-2800 cases per year in the USA, accounting for 0.1% of all deaths and 6% of liver-related deaths. It has been found that 5-6% of liver transplants are due to acute liver failure. Despite improved medical treatment and emergency organ transplantation, the mortality rate of these patients is still around 50%.
Viral agents and drug-induced hepatitis are the most common causes of acute liver failure in adults. Acute liver failure should be included in the differential diagnosis in patients with liver test abnormalities with signs of hepatic encephalopathy and prolonged prothrombin time (INR ≥1.5).
Treatment in these patients should be mostly in the form of supportive treatment and, if detectable, treatment for the causative agent. These patients should be followed up in adequate and experienced centers, as they may require urgent liver transplantation at any time, as well as good intensive care support.
Referanslar
Bernal W, Wendon J. Acute liver failure. New England Journal of Medicine. 2013;369(26):2525-34.
Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology (Baltimore, Md). 2012;55(3):965.
Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. Journal of hepatology. 2013;59(1):74-80.
Tandon B, Bernauau J, O'Grady J, Gupta S, Krisch R, Liaw YF, et al. Recommendations of the International Association for the Study of the Liver Subcommittee on nomenclature of acute and subacute liver failure. Journal of gastroenterology and hepatology. 1999;14(5):403-4.
Stravitz RT, Lee WM. Acute liver failure–Authors' reply. The Lancet. 2020;395(10240):1833-4.
Wright G, Wilmore S, Makanyanga J, McKerrell T, Watkins J, Patch D, et al. Liver transplant for adult hemophagocytic lymphohistiocytosis: case report and literature review. Exp Clin Transplant. 2012;10(5):508-12.
Lee WM, editor Etiologies of acute liver failure. Seminars in liver disease; 2008: © Thieme Medical Publishers.
Lidofsky SD. Liver transplantation for fulminant hepatic failure. Gastroenterology Clinics of North America. 1993;22(2):257-69.
Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. The Lancet. 2010;376(9736):190-201.
aasld. http:// www. aasld. org/ practiceguidelines/ Documents/ Acute Liver Failure Update 2011. pdf. (25.08.2020). 2011.
Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41(5):1179-97.
Bismuth H, Samuel D, Castaing D, Williams R, Pereira SP, editors. Liver transplantation in Europe for patients with acute liver failure. Seminars in liver disease; 1996: © 1996 by Thieme Medical Publishers, Inc.
Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. Journal of hepatology. 2012;57(2):288-96.
Bernuau J, Benhamou J. Classifying acute liver failure. The Lancet. 1993;342(8866):252-3.
Lee WM, Squires Jr RH, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: summary of a workshop. Hepatology. 2008;47(4):1401-15.
Sass DA, Shakil OA. Fulminant hepatic failure. Liver Transplantation. 2005;11(6):594-605.
Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Nevens F, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. Journal of hepatology. 2017;66(5):1047-81.
Galle P, Forner A, Llovet J, Mazzaferro V, Piscaglia F, Raoul J, et al. European Association for the Study of the Liver Electronic address eee, European Association for the Study of the L: EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69:182-236.
Lee W. Acute hepatic failure. N Engl J Med. 1993;329:1862-72.
(http://www.aasld.org/practiceguidelines/Documents/AcuteLiverFailureUpdate2011.pdf (Accessed on August 08, 2012,*** Ashwini M, Niranjan-Azadi, Araz F, Patel YA, Alachkar N, Alqahtani S, Cameron AM, et al. Ammonia level and mortality in acute liver failure:
Sola‐Vera J, Miñana J, Ricart E, Planella M, González B, Torras X, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis‐induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37(5):1147-53.
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. New England Journal of Medicine. 2012;367(2):124-34.
Auzinger G, Wendon J. Intensive care management of acute liver failure. Current opinion in critical care. 2008;14(2):179-88.
Pinsky MR, Payen D. Functional hemodynamic monitoring. Critical Care. 2005;9:1-7.
Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A. Vasopressors for the treatment of septic shock: systematic review and meta-analysis. PloS one. 2015;10(8):e0129305.
Rolando N, Harvey F, Brahm J, Philpott‐Howard J, Alexander G, Gimson A, et al. Prospective study of bacterial infection in acute liver failure: an analysis of fifty patients. Hepatology. 1990;11(1):49-53.
Rolando N, Gimson A, Wade J, Philpott‐Howard J, Casewell M, Williams R. Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure. Hepatology. 1993;17(2):196-201.
Shanmugam NP, Bansal S, Greenough A, Verma A, Dhawan A. Neonatal liver failure: aetiologies and management—state of the art. European journal of pediatrics. 2011;170:573-81.
Audimoolam VK, McPhail MJ, Wendon JA, Willars C, Bernal W, Desai SR, et al. Lung injury and its prognostic significance in acute liver failure. Critical care medicine. 2014;42(3):592-600.
Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology. 2018;69(2):406-60.
Tujios SR, Hynan LS, Vazquez MA, Larson AM, Seremba E, Sanders CM, et al. Risk factors and outcomes of acute kidney injury in patients with acute liver failure. Clinical Gastroenterology and Hepatology. 2015;13(2):352-9.
Cardoso FS, Gottfried M, Tujios S, Olson JC, Karvellas CJ, Group UALFS. Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure. Hepatology. 2018;67(2):711-20.
Urrunaga NH, Magder LS, Weir MR, Rockey DC, Mindikoglu AL. Prevalence, severity, and impact of renal dysfunction in acute liver failure on the US liver transplant waiting list. Digestive diseases and sciences. 2016;61:309-16.
MacDougall B, Bailey R, Williams R. H2-receptor antagonists and antacids in the prevention of acute gastrointestinal haemorrhage in fulminant hepatic failure: two controlled trials. The Lancet. 1977;309(8012):617-9.
Johansson P, Ostrowski S, Secher N. Management of major blood loss: an update. Acta anaesthesiologica scandinavica. 2010;54(9):1039-49.
Cordoba J, Ventura-Cots M, Simón-Talero M, Amorós À, Pavesi M, Vilstrup H, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). Journal of hepatology. 2014;60(2):275-81.
Mohsenin V. Assessment and management of cerebral edema and intracranial hypertension in acute liver failure. Journal of critical care. 2013;28(5):783-91.
Jalan R, Damink SWO, Deutz NE, Hayes PC, Lee A. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology. 2004;127(5):1338-46.
Karvellas CJ, Todd Stravitz R, Battenhouse H, Lee WM, Schilsky ML, Group UALFS. Therapeutic hypothermia in acute liver failure: a multicenter retrospective cohort analysis. Liver Transplantation. 2015;21(1):4-12.
Olson JC, Karvellas CJ. Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit. Liver Transplantation. 2017;23(11):1465-76.
Kortsalioudaki C, Taylor RM, Cheeseman P, Bansal S, Mieli‐Vergani G, Dhawan A. Safety and efficacy of N‐acetylcysteine in children with non‐acetaminophen‐induced acute liver failure. Liver transplantation. 2008;14(1):25-30.
Demetriou AA, Brown Jr RS, Busuttil RW, Fair J, McGuire BM, Rosenthal P, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Annals of surgery. 2004;239(5):660.
Mendizabal M, Silva MO. Liver transplantation in acute liver failure: A challenging scenario. World journal of gastroenterology. 2016;22(4):1523.
Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonado-Garza H. Liver cirrhosis and diabetes: risk factors, pathophysiology, clinical implications and management. World journal of gastroenterology: WJG. 2009;15(3):280.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition. 2019;38(1):48-79.
Sam J, Nguyen GC. Protein–calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver International. 2009;29(9):1396-402.
Paugam-Burtz C, Levesque E, Louvet A, Thabut D, Amathieu R, Bureau C, et al. Management of liver failure in general intensive care unit. Anaesthesia Critical Care & Pain Medicine. 2020;39(1):143-61.
Referanslar
Bernal W, Wendon J. Acute liver failure. New England Journal of Medicine. 2013;369(26):2525-34.
Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology (Baltimore, Md). 2012;55(3):965.
Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. Journal of hepatology. 2013;59(1):74-80.
Tandon B, Bernauau J, O'Grady J, Gupta S, Krisch R, Liaw YF, et al. Recommendations of the International Association for the Study of the Liver Subcommittee on nomenclature of acute and subacute liver failure. Journal of gastroenterology and hepatology. 1999;14(5):403-4.
Stravitz RT, Lee WM. Acute liver failure–Authors' reply. The Lancet. 2020;395(10240):1833-4.
Wright G, Wilmore S, Makanyanga J, McKerrell T, Watkins J, Patch D, et al. Liver transplant for adult hemophagocytic lymphohistiocytosis: case report and literature review. Exp Clin Transplant. 2012;10(5):508-12.
Lee WM, editor Etiologies of acute liver failure. Seminars in liver disease; 2008: © Thieme Medical Publishers.
Lidofsky SD. Liver transplantation for fulminant hepatic failure. Gastroenterology Clinics of North America. 1993;22(2):257-69.
Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. The Lancet. 2010;376(9736):190-201.
aasld. http:// www. aasld. org/ practiceguidelines/ Documents/ Acute Liver Failure Update 2011. pdf. (25.08.2020). 2011.
Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41(5):1179-97.
Bismuth H, Samuel D, Castaing D, Williams R, Pereira SP, editors. Liver transplantation in Europe for patients with acute liver failure. Seminars in liver disease; 1996: © 1996 by Thieme Medical Publishers, Inc.
Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. Journal of hepatology. 2012;57(2):288-96.
Bernuau J, Benhamou J. Classifying acute liver failure. The Lancet. 1993;342(8866):252-3.
Lee WM, Squires Jr RH, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: summary of a workshop. Hepatology. 2008;47(4):1401-15.
Sass DA, Shakil OA. Fulminant hepatic failure. Liver Transplantation. 2005;11(6):594-605.
Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Nevens F, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. Journal of hepatology. 2017;66(5):1047-81.
Galle P, Forner A, Llovet J, Mazzaferro V, Piscaglia F, Raoul J, et al. European Association for the Study of the Liver Electronic address eee, European Association for the Study of the L: EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69:182-236.
Lee W. Acute hepatic failure. N Engl J Med. 1993;329:1862-72.
(http://www.aasld.org/practiceguidelines/Documents/AcuteLiverFailureUpdate2011.pdf (Accessed on August 08, 2012,*** Ashwini M, Niranjan-Azadi, Araz F, Patel YA, Alachkar N, Alqahtani S, Cameron AM, et al. Ammonia level and mortality in acute liver failure:
Sola‐Vera J, Miñana J, Ricart E, Planella M, González B, Torras X, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis‐induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37(5):1147-53.
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. New England Journal of Medicine. 2012;367(2):124-34.
Auzinger G, Wendon J. Intensive care management of acute liver failure. Current opinion in critical care. 2008;14(2):179-88.
Pinsky MR, Payen D. Functional hemodynamic monitoring. Critical Care. 2005;9:1-7.
Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A. Vasopressors for the treatment of septic shock: systematic review and meta-analysis. PloS one. 2015;10(8):e0129305.
Rolando N, Harvey F, Brahm J, Philpott‐Howard J, Alexander G, Gimson A, et al. Prospective study of bacterial infection in acute liver failure: an analysis of fifty patients. Hepatology. 1990;11(1):49-53.
Rolando N, Gimson A, Wade J, Philpott‐Howard J, Casewell M, Williams R. Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure. Hepatology. 1993;17(2):196-201.
Shanmugam NP, Bansal S, Greenough A, Verma A, Dhawan A. Neonatal liver failure: aetiologies and management—state of the art. European journal of pediatrics. 2011;170:573-81.
Audimoolam VK, McPhail MJ, Wendon JA, Willars C, Bernal W, Desai SR, et al. Lung injury and its prognostic significance in acute liver failure. Critical care medicine. 2014;42(3):592-600.
Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology. 2018;69(2):406-60.
Tujios SR, Hynan LS, Vazquez MA, Larson AM, Seremba E, Sanders CM, et al. Risk factors and outcomes of acute kidney injury in patients with acute liver failure. Clinical Gastroenterology and Hepatology. 2015;13(2):352-9.
Cardoso FS, Gottfried M, Tujios S, Olson JC, Karvellas CJ, Group UALFS. Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure. Hepatology. 2018;67(2):711-20.
Urrunaga NH, Magder LS, Weir MR, Rockey DC, Mindikoglu AL. Prevalence, severity, and impact of renal dysfunction in acute liver failure on the US liver transplant waiting list. Digestive diseases and sciences. 2016;61:309-16.
MacDougall B, Bailey R, Williams R. H2-receptor antagonists and antacids in the prevention of acute gastrointestinal haemorrhage in fulminant hepatic failure: two controlled trials. The Lancet. 1977;309(8012):617-9.
Johansson P, Ostrowski S, Secher N. Management of major blood loss: an update. Acta anaesthesiologica scandinavica. 2010;54(9):1039-49.
Cordoba J, Ventura-Cots M, Simón-Talero M, Amorós À, Pavesi M, Vilstrup H, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). Journal of hepatology. 2014;60(2):275-81.
Mohsenin V. Assessment and management of cerebral edema and intracranial hypertension in acute liver failure. Journal of critical care. 2013;28(5):783-91.
Jalan R, Damink SWO, Deutz NE, Hayes PC, Lee A. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology. 2004;127(5):1338-46.
Karvellas CJ, Todd Stravitz R, Battenhouse H, Lee WM, Schilsky ML, Group UALFS. Therapeutic hypothermia in acute liver failure: a multicenter retrospective cohort analysis. Liver Transplantation. 2015;21(1):4-12.
Olson JC, Karvellas CJ. Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit. Liver Transplantation. 2017;23(11):1465-76.
Kortsalioudaki C, Taylor RM, Cheeseman P, Bansal S, Mieli‐Vergani G, Dhawan A. Safety and efficacy of N‐acetylcysteine in children with non‐acetaminophen‐induced acute liver failure. Liver transplantation. 2008;14(1):25-30.
Demetriou AA, Brown Jr RS, Busuttil RW, Fair J, McGuire BM, Rosenthal P, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Annals of surgery. 2004;239(5):660.
Mendizabal M, Silva MO. Liver transplantation in acute liver failure: A challenging scenario. World journal of gastroenterology. 2016;22(4):1523.
Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonado-Garza H. Liver cirrhosis and diabetes: risk factors, pathophysiology, clinical implications and management. World journal of gastroenterology: WJG. 2009;15(3):280.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition. 2019;38(1):48-79.
Sam J, Nguyen GC. Protein–calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver International. 2009;29(9):1396-402.
Paugam-Burtz C, Levesque E, Louvet A, Thabut D, Amathieu R, Bureau C, et al. Management of liver failure in general intensive care unit. Anaesthesia Critical Care & Pain Medicine. 2020;39(1):143-61.
