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Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States

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*
[+] Article and Author Information

From Gold Coast Hospital, Southport, Australia; University of Michigan, Ann Arbor, Michigan; University of Texas Southwestern Medical Center and Baylor University Medical Center, Dallas, Texas; University of Washington, Seattle, Washington; University of California at San Francisco, San Francisco, and University of California, Los Angeles, Los Angeles, California; University of Nebraska, Omaha, Nebraska; University of Pittsburgh, Pittsburgh, Pennsylvania; Mayo Clinic, Rochester, Minnesota; and Northwestern University, Chicago, Illinois.


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.


Ann Intern Med. 2002;137(12):947-954. doi:10.7326/0003-4819-137-12-200212170-00007
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Between January 1998 and May 2001, a 41-month period, 308 patients 15 years of age or older were enrolled from 17 tertiary care liver centers around the United States, all but one of which has a liver transplantation program. The local institutional review board of each center approved the study. All enrolled patients met entry criteria for acute liver failure: the presence of coagulopathy (prothrombin time > 15 seconds or international normalized ratio ≥ 1.5) and any hepatic encephalopathy within 26 weeks of the first symptoms without previous underlying liver disease (15). Informed consent was obtained from patients' next of kin before enrollment, according to the guidelines of local institutional review boards. On the basis of records of patients considered for enrollment but excluded because of lack of informed consent or other reasons, more than 65% of eligible patients were enrolled.

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Presumed causes and outcomes in 308 patients with acute liver failure.
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Summary for Patients

Acute Liver Failure in the United States

The summary below is from the full report titled “Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States.” It is in the 17 December 2002 issue of Annals of Internal Medicine (volume 137, pages 947-954). The authors are G Ostapowicz, RJ Fontana, FV Schiødt, A Larson, TJ Davern, SHB Han, TM McCashland, AO Shakil, JE Hay, L Hynan, JS Crippin, AT Blei, G Samuel, J Reisch, WM Lee, and the U.S. Acute Liver Failure Study Group.

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