Wednesday, July 17, 2013

Quality of life remains impaired after recovery from acute liver failure

Quality of life remains impaired after recovery from acute liver failure

Last Updated: 2013-07-16 17:40:20 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Quality of life remains impaired long after recovery from acute liver failure, especially after acetaminophen overdose, according to a study of registry data from the Acute Liver Failure Study Group (ALFSG).

"Despite how critically ill all of these acute liver failure (ALF) patients were at enrollment, they have generally done well as a group at one and two years post-ALF illness," Dr. Robert J. Fontana from the University of Michigan Medical Center in Ann Arbor told Reuters Health in an email. "Therefore, physicians should have a greater awareness of... the fact that many of these patients will need ongoing medical care even at one and two years after recovery to improve their mental and physical health."

ALF, he pointed out, is characterized by a sudden onset of coagulopathy and encephalopathy; these patients need to be rapidly triaged to a liver transplant center - "particularly those with a low likelihood of survival, like fulminant hepatitis B, autoimmune, indeterminate, and idiosyncratic drug-induced liver injury patients," he added.

Dr. Fontana and colleagues used data from the ALFSG registry to investigate differences in health-related quality of life (HRQOL) during long-term follow-up after ALF among spontaneous survivors and liver transplant recipients and to determine whether severity of illness at ALF presentation contributed to long-term HRQOL outcomes.

Among the 282 patients, 125 received new livers and 157 were spontaneous survivors (95 after acetaminophen overdose, 62 after other etiologies), as reported June 18th in Liver Transplantation online.

A median of 708 days after enrollment, CDC HRQOL-14 results demonstrated significantly worse general health and significantly more days of impaired physical health, mental health, and activities limitations due to poor physical or mental health for acetaminophen spontaneous survivors than for non-acetaminophen spontaneous survivors or for liver transplant recipients.

Compared with the other two groups, acetaminophen spontaneous survivors also reported more days of pain, depression, and anxiety.

Both groups of spontaneous survivors (acetaminophen and non-acetaminophen etiologies) had higher rates of only poor or fair general health compared with the US general population (32% vs 16%), and spontaneous survivors and liver transplant recipients were two to three times more likely than the US general population to report >14 days per month of poor physical or mental health.

Acetaminophen spontaneous survivors also fared worse on the SF-36, with significantly worse scores for pain, general health perceptions, energy/fatigue, social functioning, emotional health problems, and emotional well-being, compared with other spontaneous survivors and liver transplant recipients.

Mental health summary scores were significantly lower among the acetaminophen spontaneous survivors than among the other groups, but the three groups did not differ significantly in physical functioning, physical health problems, or physical health summary scales.

"It is difficult to determine to what extent the long-term QOL impairment observed in this study is attributable to the ALF episode itself versus pre-existing medical or psychiatric factors since baseline QOL scores were not available in these patients," the researchers note.

"From our data, we hypothesize that the underlying psychiatric and medical co-morbidities that many of these acetaminophen spontaneous survivor patients had probably was continuing to play a major role in their general health status at one and two years after recovery from their ALF episode," Dr. Fontana said.

"Therefore, going forward, I think clinicians need to carefully think through who are the optimal candidates for a liver transplant with acetaminophen and non-acetaminophen related ALF and keep in mind the importance of the patients' pre-morbid health and status when making decisions to list or proceed with liver transplant," Dr. Fontana continued.

"On a practical basis, this always boils down to making an educated assessment/estimate as to how you would believe a patient would do with an emergency liver transplant on a case by case basis. Then you do the best you can once the patient wakes up to help them recover and regain their highest level of possible functioning post-op in the setting of immunosuppression."


Liver Transplantation 2013.

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