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Changing etiological spectrum of acute liver failure

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

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.

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Data availability

Department of Gastroenterology, SMS Hospital, Jaipur, India.

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Acknowledgements

Jaya Maharshi – For typing, formatting and grammar corrections. Shalini Singh- For Statistical Analysis.

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Authors and Affiliations

  1. Department of Gastroenterology, SMS Medical College and Hospitals, Room No. 218, Superspeciality Block, Jaipur, 302 004, India

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

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  1. Saksham Seth
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  2. Sudhir Maharshi
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  3. Kamlesh Kumar Sharma
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  4. Rupesh Pokharna
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  6. Shyam Sunder Sharma
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Contributions

Saksham Seth, Kamlesh Kumar Sharma: Acquisition, analysis or interpretation of the data. Sudhir Maharshi, Rupesh Pokharna, Sandeep Nijhawan, Shyam Sunder Sharma : Study conception, design and supervision, drafting of article and critical revision for import ant intellectual content, final approval of the version to be published. Sudhir Maharshi: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved.

Corresponding author

Correspondence to Sudhir Maharshi.

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Conflict of interest

SS, SM, KKS, RP, SN and SSS declare no conflict of interest for this article.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Ethical approval

The institutional ethics committee approved the study protocol, which was conducted in accordance with the Declaration of Helinski. Patient gave their written consent.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Seth, S., Maharshi, S., Sharma, K.K. et al. Changing etiological spectrum of acute liver failure. Indian J Gastroenterol 43, 452–458 (2024). https://doi.org/10.1007/s12664-024-01578-2

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