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6401071 
Journal Article 
Significant lung injury and its prognostic significance in acute liver failure: A cohort analysis 
Dong, V; Sun, K; Gottfried, M; Cardoso, FS; Mcphail, MJ; Stravitz, RT; Lee, WM; Karvellas, CJ 
2020 
1 
Liver International
ISSN: 1478-3223
EISSN: 1478-3231 
40 
3 
654-663 
English 
31566904 
BACKGROUND AND AIMS: Respiratory failure complicating acute liver failure (ALF) may preclude liver transplantation (LT). We evaluated the association between significant lung injury (SLI) and important clinical outcomes.

METHODS: Retrospective cohort study of 947 ALF patients with chest radiograph (CXR) and arterial blood gas (ABG) data enrolled in the US Acute Liver Failure Study Group (US-ALFSG) from January 1998 to December 2016. SLI was defined by moderate hypoxaemia (Berlin classification; PaO2 /FiO2  < 200 mm Hg) and abnormalities on CXR. Primary outcomes were 21-day transplant-free survival (TFS) and overall survival.

RESULTS: Of 947 ALF patients, 370 (39%) had evidence of SLI. ALF patients with SLI (ALF-SLI) had significantly worse oxygenation than controls on admission (median PF ratio 120 vs 300 mm Hg, P < .0001) and higher lactate (6.1 vs 4.6 mmol/l, P = .0008). ALF-SLI patients had higher rates of tracheal (19% vs 14%) and bloodstream (17% vs 11%, P < .005 for both) infections and were more likely to receive transfusions (red cells 55% vs 43%; FFP 74% vs 66%; P < .009 for both). ALF-SLI patients were less likely to receive LT (18% vs 25%, P = .02) and had significantly decreased 21-day TFS (34% vs 42%) and overall survival (49% vs 64%, P < .007 for both). After adjusting for significant covariates (INR, bilirubin, acetaminophen aetiology), the development of SLI was independently associated with decreased 21-day TFS (OR 0.71, P = .03) in ALF patients (C-index 0.78). The incorporation of SLI improved discriminatory ability of the King's College Criteria (P = .0061) but not the ALFSG prognostic index (P = .34).

CONCLUSION: Significant lung injury is a common complication in ALF patients that adversely affects patient outcomes. 
; Mercury; Transplantation; Liver; Transplants & implants; Lactic acid; Acetaminophen; Survival; Syngeneic grafts; Liver diseases; Liver transplantation; Injuries; Abnormalities; Drug overdose; Lungs; Bilirubin; Radiographs; Oxygenation; Failure analysis; Allografts/