Prevalence, severity, duration and resolution of cholestasis after acute liver failure
Objective Persistent cholestasis may follow acute liver failure (ALF), but its course remains unknown. We aimed to describe the prevalence, onset, severity, duration and resolution of post-ALF cholestasis.Design Cohort of 127 adult patients with ALF at a liver transplantation centre identified using...
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| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000801.full |
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| author | Marie Sinclair Rinaldo Bellomo Adam Testro Ary Serpa Neto Paul Gow Stephen Warrillow Scott Warming Claire Michel Kartik Kishore Nada Marhoon Natasha Holmes |
| author_facet | Marie Sinclair Rinaldo Bellomo Adam Testro Ary Serpa Neto Paul Gow Stephen Warrillow Scott Warming Claire Michel Kartik Kishore Nada Marhoon Natasha Holmes |
| author_sort | Marie Sinclair |
| collection | DOAJ |
| description | Objective Persistent cholestasis may follow acute liver failure (ALF), but its course remains unknown. We aimed to describe the prevalence, onset, severity, duration and resolution of post-ALF cholestasis.Design Cohort of 127 adult patients with ALF at a liver transplantation centre identified using electronic databases. We obtained laboratory data every 6 hours for the first week, daily until day 30 and weekly, when documented, until day 180.Results Median age was 40.7 (IQR 31.0–52.4) years, median peak alanine aminotransferase level was 5494 (2521–8819) U/L and 87 (68.5%) cases had paracetamol toxicity. Overall, 12.6% underwent transplantation (3.4% for paracetamol vs 32.5% for non-paracetamol; p<0.001). Ninety-day mortality was 20.7% for paracetamol versus 30.0% for non-paracetamol patients. All non-transplanted survivors reached a bilirubin level>50 µmol/L, which peaked 3.5 (1.0–10.1) days after admission at 169.0 (80.0–302.0) µmol/L. At hospital discharge, 18.8% of patients had normal bilirubin levels and, at a median follow-up time from admission to last measurement of 16 (10-30) days, 46.9% had normal levels. Similarly, there was an increase in alkaline phosphatase (ALP) (207.0 (148.0–292.5) U/L) and gamma-glutamyl transferase (GGT) (336.0 (209.5–554.5) U/L) peaking at 4.5 days, with normalised values in 40.3% and 8.3% at hospital discharge.Conclusion Post-ALF cholestasis is ubiquitous. Bilirubin, ALP and GGT peak at 3 to 5 days and, return to baseline in the minority of patients at median follow-up of 16 days. These data inform clinical expectations of the natural course of this condition. |
| format | Article |
| id | doaj-art-9c2d9f8f8adc4619aa8c54d987280f04 |
| institution | DOAJ |
| issn | 2054-4774 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-9c2d9f8f8adc4619aa8c54d987280f042025-08-20T03:20:37ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-10-019110.1136/bmjgast-2021-000801Prevalence, severity, duration and resolution of cholestasis after acute liver failureMarie Sinclair0Rinaldo Bellomo1Adam Testro2Ary Serpa Neto3Paul Gow4Stephen Warrillow5Scott Warming6Claire Michel7Kartik Kishore8Nada Marhoon9Natasha Holmes10Department of Hepatology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, AustraliaDepartment of Critical Care, University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Hepatology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, AustraliaDepartment of Intensive Care, Albert Einstein Medical Center, Sao Paolo, BrazilDepartment of Hepatology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, AustraliaDepartment of Intensive Care, Austin Hospital, Heidelberg, Victoria, AustraliaDepartment of Intensive Care, Austin Hospital, Heidelberg, Victoria, AustraliaDepartment of Intensive Care, Austin Hospital, Heidelberg, Victoria, AustraliaData Analytics Research and Evaluation Centre, The University of Melbourne, Melbourne, Victoria, AustraliaData Analytics Research and Evaluation Centre, The University of Melbourne, Melbourne, Victoria, AustraliaData Analytics Research and Evaluation Centre, The University of Melbourne, Melbourne, Victoria, AustraliaObjective Persistent cholestasis may follow acute liver failure (ALF), but its course remains unknown. We aimed to describe the prevalence, onset, severity, duration and resolution of post-ALF cholestasis.Design Cohort of 127 adult patients with ALF at a liver transplantation centre identified using electronic databases. We obtained laboratory data every 6 hours for the first week, daily until day 30 and weekly, when documented, until day 180.Results Median age was 40.7 (IQR 31.0–52.4) years, median peak alanine aminotransferase level was 5494 (2521–8819) U/L and 87 (68.5%) cases had paracetamol toxicity. Overall, 12.6% underwent transplantation (3.4% for paracetamol vs 32.5% for non-paracetamol; p<0.001). Ninety-day mortality was 20.7% for paracetamol versus 30.0% for non-paracetamol patients. All non-transplanted survivors reached a bilirubin level>50 µmol/L, which peaked 3.5 (1.0–10.1) days after admission at 169.0 (80.0–302.0) µmol/L. At hospital discharge, 18.8% of patients had normal bilirubin levels and, at a median follow-up time from admission to last measurement of 16 (10-30) days, 46.9% had normal levels. Similarly, there was an increase in alkaline phosphatase (ALP) (207.0 (148.0–292.5) U/L) and gamma-glutamyl transferase (GGT) (336.0 (209.5–554.5) U/L) peaking at 4.5 days, with normalised values in 40.3% and 8.3% at hospital discharge.Conclusion Post-ALF cholestasis is ubiquitous. Bilirubin, ALP and GGT peak at 3 to 5 days and, return to baseline in the minority of patients at median follow-up of 16 days. These data inform clinical expectations of the natural course of this condition.https://bmjopengastro.bmj.com/content/9/1/e000801.full |
| spellingShingle | Marie Sinclair Rinaldo Bellomo Adam Testro Ary Serpa Neto Paul Gow Stephen Warrillow Scott Warming Claire Michel Kartik Kishore Nada Marhoon Natasha Holmes Prevalence, severity, duration and resolution of cholestasis after acute liver failure BMJ Open Gastroenterology |
| title | Prevalence, severity, duration and resolution of cholestasis after acute liver failure |
| title_full | Prevalence, severity, duration and resolution of cholestasis after acute liver failure |
| title_fullStr | Prevalence, severity, duration and resolution of cholestasis after acute liver failure |
| title_full_unstemmed | Prevalence, severity, duration and resolution of cholestasis after acute liver failure |
| title_short | Prevalence, severity, duration and resolution of cholestasis after acute liver failure |
| title_sort | prevalence severity duration and resolution of cholestasis after acute liver failure |
| url | https://bmjopengastro.bmj.com/content/9/1/e000801.full |
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