Changing etiological spectrum of acute liver failure

Saksham Seth; Sudhir Maharshi; Kamlesh Kumar Sharma; Rupesh Pokharna; Sandeep Nijhawan; Shyam Sunder Sharma

doi:10.1007/s12664-024-01578-2

Changing etiological spectrum of acute liver failure

Indian J Gastroenterol. 2024 Apr 27. doi: 10.1007/s12664-024-01578-2. Online ahead of print.

Authors

Saksham Seth¹, Sudhir Maharshi², Kamlesh Kumar Sharma¹, Rupesh Pokharna¹, Sandeep Nijhawan¹, Shyam Sunder Sharma¹

Affiliations

¹ Department of Gastroenterology, SMS Medical College and Hospitals, Room No. 218, Superspeciality Block, Jaipur, 302 004, India.
² Department of Gastroenterology, SMS Medical College and Hospitals, Room No. 218, Superspeciality Block, Jaipur, 302 004, India. sudhir.maharshi@gmail.com.

PMID: 38676907
DOI: 10.1007/s12664-024-01578-2

Abstract

Background and objectives: Acute liver failure (ALF) is an uncommon but potentially dramatic syndrome characterized by massive hepatic necrosis and has a very high mortality rate of 50% to 75% without liver transplantation. This study is aimed at analyzing the etiological spectrum of ALF patients and compare these with ALF mimics such as malaria, dengue fever and other tropical infectious diseases.

Methods: The study population included patients who presented with ALF and ALF mimics in a tertiary care center over two years. We retrospectively analyzed the patient case files and a comparison was made concerning the baseline demographic details, clinical profile, laboratory values and outcomes.

Results: Sixty-three patients were assessed, with 32 in ALF and 31 in ALF mimics group. The most common cause for ALF was hepatitis A virus (25%), followed by hepatitis B virus (18.7%), drug-induced liver injury (12.7%), autoimmune hepatitis (12.5%), hepatitis E virus (9.3%) and Wilson's disease (6.25%). In the ALF mimics group, malaria (58.06%) was the most common cause, followed by dengue fever (16.1%), leptospirosis (12.9%) and scrub typhus (12.9%). Patients in the ALF mimics group had significantly higher incidence of fever (p = 0.001), hepatosplenomegaly (p = 0.01), anemia (p = 0.02) and shorter jaundice to encephalopathy duration (p = 0.032) as compared to the ALF group, while higher transaminase levels (p = 0.03), bilirubin (p = 0.01), prothrombin time (p = 0.01), serum ammonia (p = 0.02) and mortality (p = 0.02) were observed in ALF patients.

Conclusions: The most common cause for ALF was hepatitis A virus, followed by hepatitis B virus, while in ALF mimics it was malaria followed by dengue fever, in our study. Patients of ALF mimics can have similar presentation, but a high index of suspicion and awareness is required to identify the common infectious ALF mimics for early diagnosis.

Keywords: Acute hepatic failure; Acute liver failure mimics; Dengue fever; Drug-induced liver injury; Hepatitis A virus; Hepatitis E virus; Leptospirosis; Malaria; Scrub typhus; Sepsis.