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

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 (I 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.