Acute liver failure: how to act?

June 29, 2023
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УДК:  616.36-008.6
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Acute liver failure (ALF) is a life-threatening condition that occurs as a result of hepatocytes’ severe damage and is accompanied by a high mortality rate due to the rapid development of progressive multiorgan failure, coagulopathy, concomitant infection or the development of cerebral edema. In the context of pathogenesis of ALF, a separate role belongs to the development of hepatic encephalopathy, which occurs as a result of an amino acid imbalance and the release of endogenous neurotoxins, the main of which is ammonium. Accumulation of ammonium in neuroglia cells leads to swelling of astrocytes, activation of inflammatory mediators, increased cerebral blood flow and brain edema. In the context of the close relationship between endogenous neurotoxins (ammonium) and the development of cerebral complications in ALF, it will be appropriate to prescribe treatment to reduce its concentration in the blood, which will prevent the hepatic encephalopathy progression and the development of intracranial hypertension. Consequently, lowering the ammonium blood level should be considered as a therapeutic goal in the management of patients with ALF.

References

1. Lee W.M., Larson A.M., Stravitz R.T. (2011) AASLD position paper: the management of acute liver failure: update 2011.

2. Bernal W., Hyyrylainen A., Gera A. et al. (2013) Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J. Hepatol., 59(1): 74–80.

3. Trey C., Davidson C.S. (1970) The management of fulminant hepatic failure. Prog. Liver Dis., 3: 282–298.

4. Polson J., Lee W.M. (2005) American Association for the Study of Liver Disease. AASLD position paper: the management of acute liver failure. Hepatol., 41(5): 1179–1197.

5. Arroyo V., Moreau R., Jalan R. (2020) Acute-on-Chronic Liver Failure. N. Engl. J. Med., 382(22): 2137–2145. doi: 10.1056/NEJMra1914900.

6. Jalan R., Williams R. (2002) Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif., 20: 252–261.

7. Ichai P., Samuel D. (2008) Etiology and prognosis of fulminant hepatitis in adults. Liver Transpl., 14(Suppl 2): 67–79.

8. Pievsky D., Rustgi N., Nikolaos T.P. (2018) Classification and Epidemiologic Aspects of Acute Liver Failure. Clinics in Liver Disease, 22(2): 229–241. doi:10.1016/j.cld.2018.01.001.

9. Westbrook R.H., Yeoman A.D., Joshi D. et al. (2010) Outcomes of severe pregnancy-related liver disease: refining the role of transplantation. Am. J. Transplant., 10: 2520–2526.

10. Chung R.T., Stravitz R.T., Fontana R.J. et al. (2012) Pathogenesis of liver injury in acute liver failure. Gastroenterol., 43(3): e1–e7. doi: 10.1053/j.gastro.2012.07.011.

11. Думанский Ю.В., Кабанова Н.В., Верхулецкий И.Е. и др. (2012) Острая печеночная недостаточность. Мед. неотл. сост., 6(45): 85–95.

12. Бондар М.В. (2012) Сучасні аспекти інтенсивної терапії печінкової енцефалопатії з позиції доказової медицини. Медицина невідкладних станів, 6(45): www.mif-ua.com/archive/article/34354.

13. Davern T.J. (2007) Predicting prognosis in acute liver failure: Ammonia and the risk of cerebral edema. Hepatol., 46(6): 1679–1681.

14. Bhatia V., Rajbir S., Acharya S.K. (2006) Predictive value of arterial ammonia for complications and outcome in acute liver failure. Gut, 55(1): 98–104.

15. Shakil A.O., Kramer D., Mazariegosal G.V. (2000) Acute liver failure: Clinical features, outcomeanalysis, and applicability of prognostic criteria. Liver Transplant., 6(2): 163–169.

16. European Association for the Study of the Liver (2017) EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J. Hepatol., 66: 1047–1081.

17. Лукашик С.П., Карпов І.А., Яговдик-Тележна Е.Н., Юркевич І.В. (2013) Гостра печінкова недостатність і методи її корекції. Гепатологія, 3: 21–39.

18. Rose C., Michalak A., Rao K.V.R. et al. (1999) L-Ornithine-L-Aspartate lowers plasma and cerebrospinal fluid ammonia and prevents brain edema in rats with acute liver failure. Hepatol., 30: 636–640.

19. Kovalic A.J., Lee T.P., Da B.L. (2022) L‐ornithine L‐aspartate in acute treatment of severe hepatic encephalopathy: a double‐blind randomized controlled trial. Hepatol., 76(5): E108–E109. doi: 10.1002/hep.32643.

20. Jain A., Sharma B.C., Mahajan B. et al. (2022) L-Ornithine-L-aspartate in acute treatment of severe hepatic encephalopathy: a double‐blind randomized controlled trial. Hepatol., 75(5): 1194–1203. doi: 10.1002/hep.32255.