Causes of liver failure and impact analysis of prognostic risk factors

Objective To perform a retrospective analysis of patients with liver failure to investigate the causative factors and related risk factors that may affect patient prognosis.Methods The clinical, demographic, and laboratory data of 79 consecutive patients diagnosed with liver failure and treated at our hospital between January 2010 and January 2012 (58 males and 21 females;age range: 16-74 years old) were collected from the medical records.To identify risk factors of liver failure, the patient variables were assessed by Student’s t-test (continuous variables) or Chi-squared test (categorical variables) .Multivariate logistic regression analysis was used to investigate the relation between patient outcome and independent risk factors.Results The 79 cases of liver failure were grouped according to disease severity: acute liver failure (n = 6;5 died) , subacute liver failure (n = 35;19 died) , and chronic liver failure (n = 38;28 died) .The overall rate of death was 66%.The majority of cases (81%) were related to hepatitis B virus infection.While the three groups of liver failure severity did not show significant differences in sex, mean age, occupation, presence of potassium disorder, total bilirubin (TBil) or total cholesterol (CHO) at admission, or lowest recorded level of CHO during hospitalization, there were significant intergroup differences in highest recorded TBil level, prothrombin activity (PTA) at admission, and highest and lowest recorded PTA, and highest recorded level of CHO.Five independent risk factors were identified: the highest recorded TBil level during hospitalization, presence of infection, hepatorenal syndrome, gastrointestinal bleeding, and hepatic encephalopathy.Conclusion The major cause of liver failure in this cohort of patients was hepatitis infection, and common biomarkers of liver function, such as TBil, CHO and PTA, may indicate patients with poor prognosis despite clinical intervention.Complications should be addressed as soon as possible to try to improve a patient’s potential for good outcome.