[Acute liver failure. Diagnosis and therapy]

Although acute liver failure is a rare disease with a prevalence of 5 per 1 million people, it has a considerablely high mortality rate of 34 %. The main causes in western civilizations are drug overdose (acetaminophen) and viral hepatitis. Patients are affected by the loss of liver synthesis function and are at risk of developing hepatic encephalopathy and possible multiorgan failure. Specific therapies consisting of the administration of N-acetylcysteine (acetaminophen) or of nucleotide/nucleoside analogs (hepatitis B) are possible, but are often not adequate. Orthotopic liver transplantation is, therefore, frequently the only remaining effective therapy for severe acute liver failure. Due to organ shortage, new prognostic tools, e.g., the Acute Liver Failure Study Group (ALFSG) score, have been developed to improve patient selection using sufficiently stringent selection criteria.