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Diagnostic criteria of acute liver failure: A report by the Intractable Hepato-Biliary Diseases Study Group of Japan

Authors

  • Satoshi Mochida,

    1. Department of Gastroenterology and Hepatology, Saitama Medical University, Moroyama-Machi
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  • Yasuhiro Takikawa,

    1. Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, Morioka
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  • Nobuaki Nakayama,

    1. Department of Gastroenterology and Hepatology, Saitama Medical University, Moroyama-Machi
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  • Makoto Oketani,

    1. Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
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  • Takafumi Naiki,

    1. Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu
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  • Yoshiyuki Yamagishi,

    1. Department of Internal Medicine, School of Medicine, Keio University, Tokyo
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  • Takafumi Ichida,

    1. Department of Gastroenterology, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
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  • Hirohito Tsubouchi

    Corresponding author
    1. Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
      Prof Hirohito Tsubouchi, Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. Email: htsubo@m2.kufm.kagoshima-u.ac.jp
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  • This article was previously published in Japanese in Kanzo 52: 6, pp. 393–398. June 2011.

Prof Hirohito Tsubouchi, Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. Email: htsubo@m2.kufm.kagoshima-u.ac.jp

Abstract

The diagnostic criteria of fulminant hepatitis in Japan are different from those of acute liver failure in Europe and the United States, both in regard to the histological features in the liver and the cutoff values of the prothrombin time. Thus, the Intractable Hepato-Biliary Disease Study Group established novel diagnostic criteria for “acute liver failure” in Japan based on the demographic and clinical features of the patients. Patients showing prothrombin time values of 40% or less of the standardized values or international normalized ratios of 1.5 or more caused by severe liver damage within 8 weeks of onset of the symptoms are diagnosed as having “acute liver failure”, where the liver function prior to the current onset of liver damage is estimated to be normal. Acute liver failure is classified into “acute liver failure without hepatic coma” and “acute liver failure with hepatic coma,” depending on the severity of the hepatic encephalopathy; the latter is further classified into two types, the “acute type” and the “subacute type”, in which grade II or more severe hepatic coma develops within 10 days and between 11 and 56 days, respectively, after the onset of disease symptoms. Patients without histological findings of hepatitis, such as those with liver damage caused by drug toxicity, circulatory disturbance or metabolic disease, are also included in the disease entity of “acute liver failure”, while acute-on-chronic liver injuries, such as liver injury caused by alcohol, are excluded. A nationwide survey of “acute liver failure” in Japan based on the novel criteria is proposed.

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