Assessment of prognosis and outcome

Overall, survival from ALF when all causes are considered is approximately 10 to 40 per cent with medical therapy alone, and 60 to 80 per cent with liver transplantation (Carace.njandVa.n.Jhiel 1995). Assessment of prognosis is the critical issue in decisions to perform urgent liver transplantation or other developing therapies. The most widely used criteria for assessment of prognosis (and therefore determination of the need for liver transplantation) were developed at King's College Hospital, London, using multivariate analysis of a series of 588 patients and were then applied prospectively to an additional group of 175 patients ( O.'.G.r.a,d.y.

etaL 1989). The factors that were predictive in patients with acetaminophen poisoning were different from those in patients with other causes of ALF. These are shown in Tibie...?, and are frequently referred to as the 'King's College criteria'. Bernuau and coworkers from the Hôpital Beaujon, Clichy, France, have developed other criteria (the 'Clichy criteria'), also shown in Table.?. Both sets of criteria have good positive predictive value but a low negative predictive value, indicating that neither could identify a subgroup at low risk of death. The cause of ALF also has some importance in assessing outcome. In general, the prognosis for spontaneous recovery is relatively good for hepatitis A infection, acetaminophen poisoning, and acute fatty liver of pregnancy, intermediate for hepatitis B infection, and poor for idiosyncratic drug reactions, fulminant Wilson's disease, and unknown etiology.

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