Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2016; 22(33): 7595-7603
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7595
Clinical management of acute liver failure: Results of an international multi-center survey
Liane Rabinowich, Julia Wendon, William Bernal, Oren Shibolet
Liane Rabinowich, Oren Shibolet, Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center and Tel-Aviv University, Tel-Aviv 64239, Israel
Julia Wendon, William Bernal, Liver Intensive Therapy Unit, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, United Kingdom
Author contributions: Wendon J and Bernal W contributed to study concept and design and acquisition of data; Rabinowich L, Wendon J, Bernal W and Shibolet O contributed to analysis and interpretation of data; Rabinowich L contributed to statistical analysis; Rabinowich L and Shibolet O contributed to drafting of the manuscript; Wendon J, Bernal W and Shibolet O contributed to critical revision of the manuscript; Bernal W and Shibolet O contributed equally.
Institutional review board statement: Non-identifiable data was gathered as part of the EuroALF registry. The study was performed with the approval of the local research ethics committee.
Informed consent statement: Survey - the participants are EUROALF members listed in appendix A. Informed consent waiver was obtained.
Conflict-of-interest statement: The authors declare no conflict of interest related to this publication.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at william.bernal@kcl.ac.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: William Bernal, MD, FRCP, Liver Intensive Therapy Unit, Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. william.bernal@kcl.ac.uk
Telephone: +44-203-2994458 Fax: +44-203-2993167
Received: January 6, 2016
Peer-review started: January 6, 2016
First decision: January 28, 2016
Revised: March 3, 2016
Accepted: March 30, 2016
Article in press: March 30, 2016
Published online: September 7, 2016
Core Tip

Core tip: Acute liver failure is rare, but carries high mortality and resource use. Standard of care and clinical practice varies between centers. In a survey conducted among members of the European-Acute-Liver-Failure consortium we have identified similarities in principles of care, including basic clinical management, recognition of severity and care of critically ill patients. Major areas of divergence were pre-intensive care unit (ICU) care and elements of ICU care. Further research is required regarding intra-cranial pressure monitoring and therapy, prophylactic antibiotics and anti-fungals, and liver support systems; we also identified a great need for improving prognostic evaluation for liver transplantation and refinement of transplantation criteria.