AI Article Synopsis
- The study focuses on understanding non-acetaminophen (APAP) drug-induced acute liver failure (ALF) by identifying risk factors and creating a predictive model for transplant-free survival (TFS).
- An analysis of 482 patients revealed that the most common cause of liver failure was herbal and dietary supplements, with a predominant hepatocellular injury pattern.
- The DIALF-5 model, developed from clinical factors, showed superior prediction for 21-day TFS compared to established models (MELD, KCC) and is validated for use in different patient cohorts, making it a practical tool for clinicians.
Article Abstract
Background: There is growing recognition of natural history, complications, and outcomes of patients who develop non-acetaminophen (APAP) drug-induced acute liver failure (ALF). To clarify high-risk factors and develop a nomogram model to predict transplant-free survival (TFS) in patients with non-APAP drug-induced ALF.
Methods: Patients with non-APAP drug-induced ALF from 5 participating centers were retrospectively analyzed. The primary endpoint was 21-day TFS. Total sample size was 482 patients.
Results: Regarding causative agents, the most common implicated drugs were herbal and dietary supplements (HDS) (57.0%). The hepatocellular type (R ≥ 5) was the main liver injury pattern (69.0%). International normalized ratio, hepatic encephalopathy grades, the use of vasopressor, N-acetylcysteine, or artificial liver support system were associated with TFS and incorporated to construct a nomogram model (drug-induced acute liver failure-5, DIALF-5). The AUROC of DIALF-5 for 7-day, 21-day, 60-day, and 90-day TFS in the internal cohort were 0.886, 0.915, 0.920, and 0.912, respectively. Moreover, the AUROC of DIALF-5 for 21-day TFS had the highest AUROC, which was significantly higher than 0.725 of MELD and 0.519 of KCC (p < 0.05), numerically higher than 0.905 of ALFSG-PI but without statistical difference (p > 0.05). These results were successfully validated in the external cohort (147 patients).
Conclusions: Based on easily identifiable clinical data, the novel DIALF-5 model was developed to predict transplant-free survival in non-APAP drug-induced ALF, which was superior to KCC, MELD and had a similar prediction performance to ALFSG-PI but is more convenient, which can directly calculate TFS at multiple time points.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10858105 | PMC |
| http://dx.doi.org/10.1007/s12072-023-10541-w | DOI Listing |
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Article Synopsis
- The study focuses on understanding non-acetaminophen (APAP) drug-induced acute liver failure (ALF) by identifying risk factors and creating a predictive model for transplant-free survival (TFS).
- An analysis of 482 patients revealed that the most common cause of liver failure was herbal and dietary supplements, with a predominant hepatocellular injury pattern.
- The DIALF-5 model, developed from clinical factors, showed superior prediction for 21-day TFS compared to established models (MELD, KCC) and is validated for use in different patient cohorts, making it a practical tool for clinicians.
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