George Ostapowicz, MD; Robert J. Fontana, MD; Frank V. Schiødt, MD; Anne Larson, MD; Timothy J. Davern, MD; Steven H.B. Han, MD; Timothy M. McCashland, MD; A. Obaid Shakil, MD; J. Eileen Hay, MD; Linda Hynan, PhD; Jeffrey S. Crippin, MD; Andres T. Blei, MD; Grace Samuel, MS; Joan Reisch, PhD; William M. Lee, MD; the U.S. Acute Liver Failure Study Group*
Acknowledgment: The authors thank the site coordinators and nurses for their support.
Grant Support: By the National Institutes of Health (RO3 DK52827, RO1 DK58369) and the U.S. Food and Drug Administration Orphan Products Program (FD-R-001661). Dr. Schiødt was supported by a Schering Research Fellowship from the American Association for the Study of Liver Diseases.
Potential Financial Conflicts of Interest:Consultancies: W.M. Lee.
Requests for Single Reprints: William M. Lee, MD, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9151.
Current Author Addresses: Dr. Ostapowicz: Department of Medicine, Gold Coast Hospital, 108 Nerang Street, Southport, QLD 4215, Australia.
Dr. Fontana: 1500 East Medical Center Drive, 3912 Taubman Center, Ann Arbor, MI 48109-0362.
Drs. Schiødt and Lee and Ms. Samuel: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9151.
Dr. Larson: Hepatology/GI/Transplant Services, University of Washington, Room EE-425, Box 356174, 1959 NE Pacific Street, Seattle, WA 98195-6174.
Dr. Davern: Department of Medicine, Gastroenterology, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143.
Dr. Han: Division of Digestive Diseases, University of California, Los Angeles, 10945 Le Conte Avenue, 2114 PVUB, Los Angeles, CA 900595-6949.
Dr. McCashland: 983285 Nebraska Medical Center, Omaha, NE 68198-3285.
Dr. Shakil: Center for Liver Diseases, Falk Medical Building, 3rd Floor, 3601 Fifth Avenue, Pittsburgh, PA 15213.
Dr. Hay: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Drs. Hynan and Reisch: Academic Computing Department, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9151.
Dr. Crippin: Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110-1093.
Dr. Blei: Northwestern University Medical School, 303 East Chicago Avenue, Searle 10-573, Chicago, IL 60611.
Author Contributions: Conception and design: G. Ostapowicz, F.V. Schiødt, A. Larson, T.J. Davern, A.O. Shakil, A.T. Blei, G. Samuel, J. Reisch, W.M. Lee.
Analysis and interpretation of the data: G. Ostapowicz, R.J. Fontana, F.V. Schiødt, L. Hynan, W.M. Lee.
Drafting of the article: G. Ostapowicz, R.J. Fontana, F.V. Schiødt, W.M. Lee.
Critical revision of the article for important intellectual content: G. Ostapowicz, R.J. Fontana, F.V. Schiødt, A. Larson, T.J. Davern, T.M. McCashland, J.S. Crippin, A.T. Blei, W.M. Lee.
Final approval of the article: G. Ostapowicz, F.V. Schiødt, A. Larson, T.J. Davern, T.M. McCashland, A.O. Shakil, L. Hynan, J.S. Crippin, A.T. Blei, G. Samuel, W.M. Lee.
Provision of study materials or patients: G. Ostapowicz, R.J. Fontana, F.V. Schiødt, A. Larson, T.J. Davern, T.M. McCashland, A.O. Shakil, J.S. Crippin, G. Samuel.
Statistical expertise: L. Hynan, J. Reisch.
Obtaining of funding: J. Reisch, W.M. Lee.
Administrative, technical, or logistic support: G. Samuel, J. Reisch, W.M. Lee.
Collection and assembly of data: G. Ostapowicz, R.J. Fontana, F.V. Schiødt, A. Larson, T.J. Davern, S.H.B. Han, T.M. McCashland, W.M. Lee.
Ostapowicz G., Fontana R., Schiødt F., Larson A., Davern T., Han S., McCashland T., Shakil A., Hay J., Hynan L., Crippin J., Blei A., Samuel G., Reisch J., Lee W., ; Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States. Ann Intern Med. 2002;137:947-954. doi: 10.7326/0003-4819-137-12-200212170-00007
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Published: Ann Intern Med. 2002;137(12):947-954.
Acute liver failure is characterized by severe and sudden liver cell dysfunction leading to coagulopathy and hepatic encephalopathy in previously healthy persons with no known underlying liver disease (1). Sometimes termed fulminant hepatic failure, acute liver failure is thought to affect approximately 2000 persons per year in the United States (2). This catastrophic illness can rapidly progress to coma and death from cerebral edema and multiorgan dysfunction (2, 3).
Over the past 30 years, the most frequently identified cause of acute liver failure has been viral hepatitis, especially hepatitis B but also hepatitis A and, in tropical populations, hepatitis E (4-8). Smaller numbers of cases have been related to drug-induced liver injury and other causes (9). The frequency of identified causes of acute liver failure has varied greatly worldwide. A very high prevalence of suicidal overdoses of acetaminophen (73%) has been recorded in the United Kingdom (10), and no cases of acetaminophen-related disease have been observed in developing countries (7).
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Gastroenterology/Hepatology, Liver Disease.
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