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Observational Study
. 2020 Oct 14;10(1):17280.
doi: 10.1038/s41598-020-74466-2.

Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury

Keisuke Kakisaka  1 , Yuji Suzuki  2 , Hiroaki Abe  2 , Takuya Watanabe  2 , Kenji Yusa  2 , Hiroki Sato  2 , Yasuhiro Takikawa  2
Affiliations
Observational Study

Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury

Keisuke Kakisaka et al. Sci Rep. .

Abstract

In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); however, the benefits of the system for patients with severe acute liver injury (SLI) remain unclear. We have evaluated the clinical significance of the referral system for SLI patients. Patients with ALI/SLI who were consecutively and prospectively listed on the system between 2004 and 2018 were analyzed. Of the 371 ALI/SLI/ALF patients on the system, 124 satisfied the criteria for SLI; 34 of these 124 progressed to SLI after registration. Multivariate analysis using age, sex, AST, ALT, creatinine, total bilirubin, prothrombin, presence of hepatic encephalopathy (HE), and SLI at registration revealed that HE was associated with high mortality. Among the 23 patients who developed HE, five who progressed to SLI after registration showed an increased time to HE development compared with patients who had SLI at the time of registration. However, there was no significant difference in survival time after HE development. We concluded that early identification of SLI patients using the referral system increased the time from SLI diagnosis to HE development.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Graphs of the cumulative rate of development of hepatic encephalopathy after diagnosis of acute liver failure. SLI severe acute liver injury, ALI acute liver injury.
Figure 2
Figure 2
Cumulative rate of transplant-free survival in patients with acute liver failure. SLI severe acute liver injury, ALI acute liver injury.
See this image and copyright information in PMC

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