Diagnosis and Management of Acute Liver Failure
Publication Date: February 1, 2017
Last Updated: December 16, 2022
Diagnosis
Summary of Recommendations of the AGA Clinical Guidelines for the Diagnosis and Management of Acute Liver Failure (ALF)
In patients presenting with ALF, the AGA suggests against routinely testing all patients for Wilson’s disease. ( Very Low , Conditional (weak) )
Comments: In a setting of high clinical suspicion, testing for Wilson’s disease can be considered, keeping in mind the low positive predictive value. Although the management and outcome of ALF would not be altered, identification of Wilson’s disease would allow appropriate post-transplantation management and screening of the patient’s family members.
612
In patients presenting with ALF, the AGA suggests testing for herpes simplex virus (HSV) and treatment of patients with HSV. ( Very Low , Conditional (weak) )
612
In immunocompetent patients presenting with ALF, the AGA suggests against routinely testing all patients for varicella zoster virus (VZV). ( Very Low , Conditional (weak) )
612
In pregnant women presenting with ALF, the AGA suggests testing for hepatitis E. ( Very Low , Conditional (weak) )
612
In patients presenting with ALF, the AGA suggests using the MELD score rather than the Kings College Criteria (KCC) as a prognostic scoring system. ( Very Low , Conditional (weak) )
Comment: A Model for End-Stage Liver Disease (MELD score of 30.5 (fixed cut-off level) should be used for prognosis; higher scores predict the need for liver transplantation.
612
In patients presenting with ALF, the AGA suggests against the routine use of liver biopsy. ( Very Low , Conditional (weak) )
612
In patients presenting with ALF, the AGA suggests autoantibody testing for autoimmune hepatitis be performed. ( Very Low , Conditional (weak) )
612
Treatment
Summary of Recommendations of the AGA Clinical Guidelines for the Diagnosis and Management of Acute Liver Failure (ALF)
In patients presenting with ALF, the AGA suggests against the empiric use of treatments to reduce intracranial pressure (ICP). ( Very Low , Conditional (weak) )
612
In patients presenting with ALF, the AGA recommends that extracorporeal artificial liver support systems be used within the context of a clinical trial. ( Evidence Gap , No recommendation )
612
In patients presenting with acetaminophen-associated ALF, the AGA recommends the use of N-acetyl cysteine (NAC) in acetaminophen-associated ALF. ( Very Low , Strong )
612
In patients presenting with non–acetaminophen-associated ALF, the AGA recommends that NAC only be used only in the context of clinical trials. ( Evidence Gap , No recommendation )
612
Recommendation Grading
Overview
Title
Diagnosis and Management of Acute Liver Failure
Authoring Organization
American Gastroenterological Association
Publication Month/Year
February 1, 2017
Last Updated Month/Year
March 25, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Emergency care, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Management
Diseases/Conditions (MeSH)
D008107 - Liver Diseases, D017114 - Liver Failure, Acute, D017093 - Liver Failure
Keywords
liver disease, acute liver failure, Fulminant Hepatic Failure, ALF