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Acute liver failure

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Acute hepatic failure occurs when there is a massive loss of hepatocytes. It is defined as severe hepatic dysfunction occuring within 6 months of the onset of symptoms of liver disease, with a clinical manifestation of hepatic encephalopathy or coagulopathy.

It is further subdivided to describe fulminant liver failure - symptoms occuring in eight weeks, and subacute, subfulminant or late onset liver failure occuring in the rest of the 6 month period.

A new terminology however has been suggested to acknowledge the clinical finding that patients with a more rapid onset of hepatic failure are more likely to recover. This classification is as follows: hyperacute - encephalopathy within seven days of the onset of jaundice, acute - encephalopathy after 8-28 days of jaundice and subacute - when encephalopathy occurs 5-12 weeks after the onset of jaundice.

The subclassification of acute liver failure is not internationally standardised. Earlier discrimination of patients is of most use when considering those most appropriate for transplantation.

Patients may develop hepatic encephalopathy (HE) which causes significant symptoms and impaired quality of life

  • a review (16 studies; n=1376) found lactulose improved overall quality of life measured by the Sickness Impact Profile (estimated pooled mean difference of 6.92 [95% CI 6.66–7.18]) (1)
    • difference seen with rifaximin was not statistically significant (4.76 [-4.23 to 13.76])


  • Moon AM et al. Systematic Review and Meta-Analysis on the Effects of Lactulose and Rifaximin on Patient-Reported Outcomes in Hepatic Encephalopathy. The American Journal of Gastroenterology 118(2):p 284-293, February 2023. | DOI: 10.14309/ajg.0000000000002008

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