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Acute liver failure in Sweden: etiology and outcome
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2007 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 3, 393-401 p.Article in journal (Refereed) Published
Abstract [en]

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 ≥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.

Place, publisher, year, edition, pages
2007. Vol. 262, no 3, 393-401 p.
Keyword [en]
Acute liver failure, Etiology, King's College Hospital criteria, Liver transplantation, Outcome
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-16036DOI: 10.1111/j.1365-2796.2007.01818.xISI: 000249267500010PubMedID: 17697161OAI: oai:DiVA.org:uu-16036DiVA: diva2:43807
Available from: 2008-06-02 Created: 2008-06-02 Last updated: 2011-01-27Bibliographically approved

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Lööf, Lars
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Department of Medical SciencesCentre for Clinical Research, County of Västmanland
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