Acute liver failure risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

The risk factors in the development of acute liver failure can be categorized into viral, drugs and toxins, vascular, metabolic and systemic illnesses. Common risk factors of acute liver failure include acetaminophen toxicity, viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E), alcoholic hepatitis, autoimmune hepatitis, sepsis, heart failure, renal failure, immunocompromised state, older age and malnourishment. Acetaminophen toxicity is the most common risk factor of acute liver failure in the developed world and viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E) is most common in the developing world.

Risk factors in the development of acute liver failure include:^{[1][2][3][4][2][5]}

• Drug-related hepatotoxicity and idiosyncratic drug reactions are the most common risk factor in the developed world. The most common drug causing hepatotoxicity is acetaminophen.
• Viral hepatitis is the most common risk factor of acute liver failure in the developing world.
  • Hepatitis A virus, Hepatitis B virus, Hepatitis D virus, or Hepatitis E virus.
  • Other atypical viruses causing viral hepatitis and fulminant hepatic failure include cytomegalovirus, hemorrhagic fever viruses, herpes simplex virus, paramyxovirus and Epstein-Barr virus.
• Old age
• Malnourishment
• Vascular diseases
  • Ischemic hepatitis
  • Hepatic vein thrombosis (Budd-Chiari syndrome)
  • Hepatic veno-occlusive disease
  • Portal vein thrombosis
• Autoimmune disease
  • Autoimmune hepatitis
• Metabolic diseases
  • Acute fatty liver of pregnancy
  • Alpha-1 antitrypsin deficiency
  • Reye syndrome
  • Tyrosinemia
  • HELLP syndrome
• Malignancy
  • Primary liver tumor: Hepatocellular carcinoma
  • Secondary liver tumor: Extensive hepatic metastases or infiltration from breast cancer, lung cancer, melanoma, lymphoma, leukemia.
• Long-term alcohol consumption
• Immunocompromised state
• Other systemic diseases
  • Sepsis
  • Cardiac failure
  • Respiratory failure
  • Renal failure

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