Clinical profile and outcome of patients with indeterminate acute liver failure

Background: Acute liver failure (ALF) is a rare medical emergency and devastating clinical syndrome associated with high mortality. Indeterminate ALF still forms a significant number of cases in India as well in the world. We aimed to determine the clinical profile and outcome of patients with indeterminate ALF.Methods: A total of 30 patients with a diagnosis of Indeterminate ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, severity of liver injury, outcome, complications and duration of hospital stay.Results: Overall mortality was 18 (60%). Majority of the patients were females (56.7%). Majority of patients (60%) had grade III and IV encephalopathy at the time of admission. The mean age in Survived group was 30.6±11.6 years and in Died group was 42.6±10.2 years (p=0.005). INR, bilirubin AST, ALT and creatinine were significantly higher in Died group than Survived group. Mean grade of coma was significantly higher in Died group than Survived group (p=0.010). MELD Score was significantly higher in Died group 35.8±6.7 than Survived group 27.5±5.8 (P = 0.001). Sepsis and renal failure occurred more frequently in Died group. Duration of hospital stay was also significantly more in Died group versus Survived group (p=0.003).Conclusions: Indeterminate ALF disproportionately affected young females. Mortality was as high as 60%. The marked difference in spontaneous survival can be explained by the severity of hepatic dysfunction on admission and more frequent complications.

N-acetylcysteine treatment in viral-induced acute liver failure

Background:Acute liver failure (ALF) is characterized by acute derangement of liver function and carries high mortality. Viral hepatitis is still one of the main causes of ALF in the India as well in world. A prospective case control study was carried with the aim to determine the effect of N-acetylcysteine (NAC) on survival ofviral-ALFpatients.Methods:37 patients with a diagnosis of viral-ALFwere included in the study. 18 patients received NAC infusion for 72hrs whereas 19 patients in control group received placebo. The variables evaluated were demographic, biochemical, outcome and length of hospital stay.Results:Out of 37viral-ALFpatients, acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). The two groups were comparable for the various baseline characteristics (age, INR, bilirubin,ALT, creatinine, albumin, grade of encephalopathy,mean grade of comaetc.). Use of NAC was associated with a shorter length of hospital stay of survived patients (p=0.024). A total of 20 of 37 (54.1%) patients died with ALF complications; 7 (38.9%) patients belonged to NACgroup and 13 (68.4%) patients to control group (p=0.079).HEV induced ALFshowed significant improved in survival than Non HEV inducedALF with NAC administration (p=0.022). Conclusions: HEV was the most frequently cause ofviral-ALF. Overall survival was not improved by NAC. HEV induced ALFshowed significant improved in survival than Non HEV inducedALF with NAC administration.NAC reduced duration of hospital stay

Etiology and outcome of patients with viral-induced acute liver failure

Background: Acute liver failure (ALF) is a rare medical emergency and devastating clinical syndrome associated with high mortality in the absence of immediate intensive supportive care, specific treatment, or liver transplantation. Viral hepatitis is still one of the main causes of ALF in the India as well in world. We aimed to determine the etiology of Viral-ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis E and non HEV group in this prospective study.Methods: A total of 37 patients with a diagnosis of viral-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, severity of liver injury, outcome, complications and duration of hospital stay.Results: Out of 37 Viral-ALF patients, Acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). There were significantly more females in HEV group (61.1%) than non HEV group (21.1%) (P = 0.014). Overall mortality was 20 (54.1%). Mortality was higher in non HEV group (73.7%) than HEV group (33.3%) (P = 0.015). The mean age in HEV group was 30±12.7 years and in non HEV group was 38.1±10.4 years (P = 0.042). Bilirubin, ALT, mean grade of coma and interval between jaundice and encephalopathy were significantly higher in non HEV group than HEV group. MELD Score was higher in non HEV group 32.6±7.9 than HEV group 26.3±7.2 (P = 0.012). Sepsis and renal failure occurred more frequently in non HEV group than HEV group. Duration of hospital stay was also significantly more in non HEV group 11.3±3.3 days versus HEV group was 7.9 ± 2.9 (P = 0.002).Conclusions: HEV was the most frequently associated with Viral-ALF. HEV related ALF disproportionately affected young women. Mortality was higher in non HEV group (73.7%) than HEV group (33.3%). The marked difference in spontaneous survival between HEV and non HEV group can be explained by the severity of hepatic dysfunction on admission and more frequent complications.

A prospective study of N-acetylcysteine treatment in drug-induced fulminant hepatic failure

Background: Acute liver failure (ALF) is a rare but severe, life-threatening, complex, multisystemic gastroenterological emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. To date, there is no established treatment for DI-ALF other than liver transplantation and little is known about the use of N-acetylcysteine (NAC) in DI-ALF. A prospective case-control study was carried with the aim to determine the effect of NAC on mortality of DI-FHF patients and also to evaluate the safety and efficacy of NAC use.Methods: A total of 18 patients with a diagnosis of DI-FHF were included in the study. 10 patients received NAC infusion for 72 hours whereas the control group received placebo. The variables evaluated were demographic, signs and symptoms, biochemical parameters, outcome and length of hospital stay.Results: Out of 18 DI-FHF patients, 13 (72.2%) had anti-tuberculosis therapy (ATT) induced FHF and 5 (27.8%) patients had ayurvedic induced FHF. The two groups were comparable for the various baseline characteristics (age, INR, alanine aminotransferase, creatinine, albumin, grade of encephalopathy, etc.). The mortality decreased to 20% with the use of NAC versus 75% in the control group (P=0.023). Use of NAC was associated with a shorter length of hospital stay of survived patients (P=0.043). Moreover, the overall survival was improved by NAC (P=0.023) in DI-FHF. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF use (P=0.019).Conclusions: Author recommended the use of NAC along with conventional treatments in patients with DI-FHF in non-transplant centers while awaiting referrals. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF with NAC administration and its use was safe.

Comparative study of etiological profile and outcome in acute liver failure

Background:Acute liver failure (ALF) is a clinical syndrome that is marked by the sudden loss of hepatic function in a person without chronic liver disease. Clinical and etiological profile varies with geographical area and over time. The objective of this prospective study was to determine the etiological profile and outcome of ALF and to compare it with other major studies from India and US. Methods:A total of 84 consecutive patients with a diagnosis of ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, etiological profile and outcome.Results:Viral hepatitis 32 (38.1%) was the most common cause of ALF but large number of the patients 30 (35.7%) had indeterminate aetiology. Among viral causes, acute hepatitis E (19.1%) was most common followed by hepatitis B (9.5%) and A (9.5%). Drug or toxic induced liver failure (17.8%) also contributed a significant proportion. Majority of the patients were male (51.9%) and the mean age was 39.48±20.11 years. Aetiology varied with other geographical area and even over time in the same area. Overall mortality was 44 (57.1%) in ALF patients, with highest mortality in indeterminate group (60%).Conclusions:Like the rest of India, viral hepatitis was the common cause of ALF but a large number of patients 30 (35.7%) had indeterminate aetiology. Overall mortality was 57.1%. Our study highlights the differences in the profile of ALF from other earlier studies in India and the west

Comparison of cardiac autonomic response in different ABO blood groups of young adults

Background: ABO blood group has been associated with various disease phenotypes, particularly cardiovascular disease. Abnormal autonomic response also plays a role in cardiac morbidity. Increasing attention is being focused on the role of autonomic nervous system in health and disease. The literature lacks data on the association of blood groups and cardiac autonomic function. The aim of the study was to find out the association between different blood groups and cardiovascular autonomic functions in young adults.Methods: 150 healthy young students of MMU aged 18-25 years, divided into four groups based on ABO blood grouping, determined by agglutination test (group A, group B, group O and group AB). Various autonomic function tests done were lying to standing test, Valsalva maneuver, Hand grip test (HGT) and Cold pressor test (CPT).Results: The mean baseline heart rate was significantly higher in group O as compared to group A. No parasympathetic alteration between different ABO blood groups was seen. Blood pressure response to HGT and CPT was not statistically significant between different blood groups.Conclusions: Present study revealed no alteration in cardiac autonomic function with regards to ABO blood grouping in young adults.

Clinical features, laboratory characteristics and outcome of patients with drug-induced acute liver failure

Background: Acute liver failure (ALF) is a rare medical emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. Clinical and etiological profile varies with geographical area and time. A prospective study of DI-ALF was carried with the aim to determine the clinical features, laboratory characteristics, outcome and hospital course.Methods: A total of 15 patients with a diagnosis of DI-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters [bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), internal normalization ratio (INR) etc.], outcome and course during hospitalization.Results: Out of 15 DI-ALF patients, 12 had Anti-tuberculosis therapy (ATT) induced ALF and 3 patients had ayurvedic induced ALF. Majority of the patients were females (73.3%) and middle-aged (42.60±14.30 years). Coma grade at the time of admission showed that majority of patients (66.8%) had grade I and II encephalopathy. Depending on the pattern of liver injury, hepatocellular pattern was most common (53.3%) followed by mixed and cholestatic pattern. 40% of patients died with DI-ALF complications of which ATT induced ALF contributed 41.7%. Mean AST was more increased as compared to ALT. Development of ascites (P = 0.030) and mannitol use (P = 0.025) was significantly more common in non survived group than survived group. Length of hospital stay was significantly more in non survived group than survived group (P = 0.009).Conclusions: ATT was the class of drugs most frequently associated with DI-ALF. DI-ALF disproportionately affected middle-aged women. Most DILI ALF patients had hepatocellular injury pattern. 40% of patients died with DI-ALF complications. Development of ascites, mannitol use and length of hospital stay was significantly more in non survived group than survived group.

Effect of Body Mass Index on Cardiac Autonomic Functional Status in Healthy Young Adults

Introduction: Autonomic nervous system (ANS) is involvedin energy metabolism and regulation of the cardiovascularsystem. Autonomic dysfunction has been suggested tooccur in obese individuals in both adults and children but acomprehensive study of the autonomic status in young adultsis scant. So aim of the study was to evaluate and comparecardiovascular autonomic functions in young adults on thebasis of BMI.Material and methods: 150 healthy young students of MMUaged 18–25 years, divided into four groups based on BMI asper Asian criteria (underweight, normal weight, overweightand obese). Various autonomic function tests done were Lyingto Standing test, Valsalva manoeuvre, Hand grip test (HGT)and Cold pressor test (CPT).Results: The mean baseline SBP and DBP were significantlyhigher in obese subjects followed by overweight, normalweight and under weight. No parasympathetic alterationbetween different BMI groups was seen. Mean values ofresting SBP and DBP were significantly higher and bloodpressure response to HGT and CPT was significantly lower inobese as compared to normal weight subjects.Conclusion: Our study revealed an altered autonomicfunction in the form of impaired sympathetic activity withno parasympathetic modulation in obese young adults. Soweight reduction and moderate intensity aerobic exerciseprogrammes should be incorporated into daily living, whichmay delay or prevent the onset of hypertension.