Author(s): Wei G, Bergquist A, Broom U, Lindgren S, Wallerstedt S,
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Abstract OBJECTIVE: To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome. RESEARCH DESIGN AND METHODS: Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included. RESULTS: A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42\% and other drugs in 15\%. In 31 cases (11\%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67\%, negative-predictive value (NPV) of 84\% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54\% and 63\% respectively. MELD score>30 had a positive-predictive value of 21\%, negative-predictive value of 94\% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64\% and 76\% respectively. CONCLUSIONS: Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.
This article was published in J Intern Med
and referenced in Emergency Medicine: Open Access