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Population-based surveillance for acute liver failure.

William A Bower1, Matthew Johns, Harold S Margolis

  • 1Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

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This population-based study found acetaminophen-related acute liver failure (ALF) is common, especially in adults. Further research is needed for ALF of undetermined causes, particularly in children.

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Area of Science:

  • Hepatology
  • Public Health Surveillance
  • Epidemiology

Background:

  • Most U.S. acute liver failure (ALF) studies occur at specialized centers.
  • Population-based data on ALF incidence and etiology are limited.

Purpose of the Study:

  • To conduct population-based surveillance for acute liver failure (ALF).
  • To determine the incidence, etiologies, and outcomes of ALF in Metropolitan Atlanta.

Main Methods:

  • Population-based surveillance for ALF in 8 Atlanta counties (2000-2004).
  • ALF cases defined by coagulopathy and hepatic encephalopathy without prior liver disease.
  • Data collected via questionnaires and medical record review.

Main Results:

  • Annualized incidence of ALF was 5.5 per million.
  • Acetaminophen (APAP)-related ALF was the most common cause in adults (41%).
  • Undetermined etiology was most common in children (38%); Blacks had higher rates of undetermined ALF.

Conclusions:

  • An estimated 1,600 ALF cases occur annually in the U.S.
  • APAP-related ALF is a leading cause, consistent with prior studies.
  • Further research into undetermined ALF, especially in children, is warranted.