Diagnosis and Management of Acute Liver Failure
Publication Date: February 1, 2017
Last Updated: December 16, 2022
Diagnosis
Summary of Recommendations of the AGA Clinical Guidelines for the Diagnosis and Management of Acute Liver Failure (ALF)
In patients presenting with ALF, the AGA suggests against routinely testing all patients for Wilson’s disease. ( Very Low , Conditional (weak) )
Comments: In a setting of high clinical suspicion, testing for Wilson’s disease can be considered, keeping in mind the low positive predictive value. Although the management and outcome of ALF would not be altered, identification of Wilson’s disease would allow appropriate post-transplantation management and screening of the patient’s family members.
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In patients presenting with ALF, the AGA suggests testing for herpes simplex virus (HSV) and treatment of patients with HSV. ( Very Low , Conditional (weak) )
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In immunocompetent patients presenting with ALF, the AGA suggests against routinely testing all patients for varicella zoster virus (VZV). ( Very Low , Conditional (weak) )
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In pregnant women presenting with ALF, the AGA suggests testing for hepatitis E. ( Very Low , Conditional (weak) )
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In patients presenting with ALF, the AGA suggests using the MELD score rather than the Kings College Criteria (KCC) as a prognostic scoring system. ( Very Low , Conditional (weak) )
Comment: A Model for End-Stage Liver Disease (MELD score of 30.5 (fixed cut-off level) should be used for prognosis; higher scores predict the need for liver transplantation.
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In patients presenting with ALF, the AGA suggests against the routine use of liver biopsy. ( Very Low , Conditional (weak) )
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In patients presenting with ALF, the AGA suggests autoantibody testing for autoimmune hepatitis be performed. ( Very Low , Conditional (weak) )
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Overview
Title
Diagnosis and Management of Acute Liver Failure
Authoring Organization
American Gastroenterological Association