A Systematic Review on Prognostic Indicators of Acute Liver Failure and Their Predictive Value for Poor Outcome

Aims: To systematically identify and summarize prognostic indicators in patients with acute liver failure and to evaluate their predictive value. To analyse a wide spectrum of indicators used worldwide for prediction of outcome in patients with acute liver failure as a starting point for a better prognostic index.
Methodology: Online databases MEDLINE® (1950-2014) and EMBASE® (1980-2014) were searched and studies published up to 01 January 2014 were considered. Articles were included if they reported original data from a clinical trial or observational study on patients with diagnosis of acute liver failure or fulminant hepatic failure and if one of their main objectives was evaluating prognostic indicators of acute liver failure outcome. Of 1835 identified studies 119 were included for detailed analysis.
Results: Based on 289 selected indicators and their effect on patient outcome following 8 categories were formed: general markers (n=32), bio-markers (n=131), hemodynamic (n=14), liver function tests (n=7), imaging/morphology (n=15), scoring systems (n=53), time intervals (n=17), and treatments (n=20). The most frequently reported indicators were: bilirubin, age creatinine, coagulopathy expressed by prothrombin time or INR and hepatic encephalopathy.
Conclusion: This review provides a large amount of information, including the extensive list of worldwide used indicators to predict outcome in patients with acute liver failure. There is large heterogeneity in prognostic indicators of acute liver failure, methods of measurement, complexity of calculation and threshold values. Based on this large list of indicators we suggest that an ideal prognostic index should preferentially be based on pathophysiological aspects and has to be applied in a dynamic way. Future studies on acute liver failure can profit from this inventory.