Acute Liver Failure in a Metropolitan Area in Germany: a Retrospective Study (2002 – 2008)

Zusammenfassung

Ziele: Identifikation aktueller Ätiologien des akuten Leberversagens (ALV) in Deutschland sowie neuer prognostischer klinischer und / oder Laboratoriumsparameter des klinischen Verlaufs. Patienten: 134 erwachsene ALF-Patienten (63 % w / 37 % m) in einem Alter von 41 ± 16 Jahren (Median: 38 Jahre). Design und Setting: Retrospektive Studie (1 / 2002 – 4 / 2008) an ALF-Patienten des Ruhrgebiets, der größten urbanen Region Nordwestdeutschlands. Nach Studienaufnahme wurden klinische und Laboratoriumsparameter über 4 Wochen hinweg erhoben. Ergebnisse: ALF-Ätiologien waren Medikamententoxizität (39,6 %), Kombinationen viraler Hepatitiden (23,1 %) oder heterogen (16,4 %). In 20,9 % der Fälle konnte keine Ursache ermittelt werden. Das 4-Wochen-Überleben betrug 81,3 %. Unter Standardtherapie erholten sich 89 Patienten (66,4 %); 26 Patienten (19,4 %) mussten lebertransplantiert werden. Erhöhte Body-Mass-Indices (BMIs) korrelierten signifikant (p < 0,003) mit einem ungünstigen Verlauf, während hohe Spiegel cholestatischer Enzyme signifikant (p < 0,01) mit einem positiven Verlauf korrelierten. Schlussfolgerungen: Mit dieser Studie wurden nach langer Zeit erstmals aktuelle ALF-Ätiologien in Deutschland ermittelt. Demnach haben in der untersuchten Modellregion Deutschlands v. a. Acetaminophen-assoziierte, aber auch andere Fälle von Medikamententoxizität virale Hepatitiden als häufigste singuläre ALF-Ätiologie ersetzt. Gleichsinnige Befunde liegen aus den USA, Großbritannien und Skandinavien vor. Niedrige BMIs und erhöhte Cholestase-Parameter waren von statistisch signifikantem prognostischem Wert.

Abstract

Objectives: To determine current etiologies of acute liver failure (ALF) and clinical and laboratory parameters associated with the outcome upon ALF, so as to identify the frequency of present causes of ALF in Germany as well as potential new prognostic parameters. Patients: 134 adult patients (63 % females / 37 % males) aged 41 ± 16 years (median: 38 years) with established ALF criteria. Design and setting: A retrospective study (1 / 2002 – 4 / 2008) on ALF patients from the Ruhr Area, the largest urban region located in northwestern Germany. Clinical and laboratory data were collected for a period of four weeks after study admission. Results: Etiologies of ALF were identified as drug toxicity (39.6 % of the cases); combined viral hepatitides (23.1 %); or miscellaneous (16.4 %). In 20.9 % of the cases, the etiology remained indeterminate. Overall patient survival at four weeks was 81.3 %. While 89 patients (66.4 %) recovered under best supportive therapy, 26 patients (19.4 %) had to undergo liver transplantation. Increased body mass indices were significantly (p < 0.003) associated with a poor outcome. Intriguingly, high levels of cholestatic enzymes significantly (p < 0.01) correlated with a positive outcome. Conclusions: In providing first data on current ALF etiologies Germany, this study reveals that drug toxicity – in particular due to acetaminophen – has replaced viral hepatitis as the most single frequent cause of ALF in a densely populated urban area; this correlates with similar findings in the USA, the UK and Scandinavia. Lower body mass indices and elevated cholestatic enzyme levels had statistically significant prognostic power.

Acetaminophen - Medikamententoxizität - Epidemiologie - Cholestase - Body-Mass-Index

acetaminophen - drug toxicity - epidemiology - cholestasis - body mass index

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2 To be considered as co-first authors.