Acute liver failure causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

The causes of acute liver failure can be categorized into viral, drugs and toxins, vascular, and metabolic. Common causes of acute liver failure include acetaminophen toxicity, viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E), alcoholic hepatitis, autoimmune, sepsis, right heart failure, and idiopathic. Acetaminophen toxicity is the most common cause of acute liver failure in the developed world and viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E) is most common in the developing world.

Causes

Common Causes

The common causes of acute liver failure are:^[1]^[2]^[3]^[4]^[2]^[5]

Acetaminophen overdose, the reason is usually suicidal intent. Additionally, the toxic threshold dose of acetaminophen decreases in some cases, such as in chronic alcoholics, diabetics, and while fasting. Drug-induced acute liver failure is the most common cause in the developed world. It is responsible for more than 50% of the cases of acute liver failure in the United States.
Idiosyncratic reactions to medications such as tetracycline, troglitazone, antituberculosis drugs, and anti-epileptic drugs
Viral hepatitis (hepatitis A, B and hepatitis E) are the most common. The incidence of acute liver failure in post-viral hepatitis has decreased due to the vaccination and improved sanitation in the developed world. However, it is still the most common cause in the developing world.
Alcohol
Autoimmune hepatitis
Acute fatty liver of pregnancy
Reye syndrome
Wilson's disease
Idiopathic (without an obvious cause)
Diseases of fatty acid oxidation pathways
Parvovirus B19 infection
Budd–Chiari syndrome
Malignancy such as lymphomas
Shock
Sepsis
Hyperthermia
Hypothermia
HELP syndrome

Causes by Organ System

Cardiovascular	Cardiomyopathy, Congestive heart failure, Heart surgery, Hypoplastic left heart syndrome, Hypotension, Myocarditis, Shock
Chemical / poisoning	8-Hyydroxyquinoline, Amanita phalloides, Amatoxins, Carbon tetrachloride, Ethanol, Gold, Gyromitrin, Iron compounds, Mushroom poisoning, Senecio, Toluene, Yellow phosphorous, Bacillus cereus , Cyanobacteria
Dermatologic	No underlying causes
Drug Side Effect	Abacavir, Acetaminophen, Acetaminophen and Oxycodone, Albendazole, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Amoxicillin-clavulanate, Anticonvulsants, Antituberculosis drugs, Aspirin, Atorvastatin, Bromfenac , Carbamazepine, Chaparral, Chelidonium, Ciprofloxacin, Comfrey, Cyclophosphamide, Dantrolene, Dapsone, diclofenac (patch), Didanosine, Dideoxyinosine, Disulfiram, Doxycycline, Efavirenz, Ephedra, Erlotinib, Erythromycin, Etodolac, Fluoroquinolones, Flutamide, Gemtuzumab, Gemtuzumab, Germander tea, Ginseng, Halothane, He Shou Wu, Hydroxychloroquine, Imipramine, Interferon beta, Isoflurane, Isoniazid, Ixabepilone, Kava kava, Ketoconazole, Labetalol, Leflunomide, Loratadine, Lovastatin, Ma Huang, MAO inhibitors, Meloxicam, Methotrexate, Methyldopa, Moxifloxacin, Niacin, Nevirapine, Nicotinic acid, Nitisinone, Nitrofurantoin, Nortriptyline, NSAIDs, Oral contraceptive pills , Pazopanib, Pemoline, Pennyroyal, Phenytoin, Propylthiouracil, Pyrazinamide, Regorafenib, Rifampin, Simvastatin, Skull cap, Statins, Sulfacetamide, Sulfasalazine, Suloctidil, Terbinafine, Tetracycline, Teucrium polium, Tolcapone, Tricyclic antidepressants, Troglitazone, Valproic acid, Ecstacy, Cocaine, Reye's syndrome
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Budd-Chiari syndrome, Cirrhosis, Hepatic arterial thrombosis, Hepatic veno-occlusive disease, Ischemic hepatitis, Portal vein thrombosis, Alpha1-antitrypsin deficiency, Acute fatty liver of pregnancy, Liver tumor, Autoimmune hepatitis
Genetic	Alpha1-antitrypsin deficiency, Carnitine palmitoyltransferase 1 deficiency, Fructose intolerance, Galactosemia, Hemochromatosis, LCAT deficiency, Sickle cell disease, Tyrosinemia, Wilson's disease, HELLP syndrome
Hematologic	Hemosiderosis, Hemochromatosis, Sickle cell disease, HELLP syndrome, Leukemia
Iatrogenic	Extracorporeal membrane oxygenation, Hepatectomy, Reye's syndrome
Infectious Disease	Adenovirus, Bacillus cereus , Cyanobacteria, Cytomegalovirus, Echovirus, Epstein-Barr virus, Fasciola hepatica, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Herpes simplex, Leptospirosis, Non A non B hepatitis , Parainfluenza viruses, Parvovirus, Sepsis, Viral hemorrhagic fever, Viral hepatitis, Visceral leishmaniasis
Musculoskeletal / Ortho	Adult onset Still's disease
Neurologic	No underlying causes
Nutritional / Metabolic	Fatty acid oxidation pathway diseases, Hemochromatosis, Carnitine palmitoyltransferase 1 deficiency, Fructose intolerance, Galactosemia, LCAT deficiency, Tyrosinemia, Wilson's disease
Obstetric/Gynecologic	Acute fatty liver of pregnancy, HELLP syndrome
Oncologic	Leukemia, Liver tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Abacavir, Acetaminophen, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Amoxicillin-clavulanate, Anticonvulsants, Antituberculosis drugs, Aspirin, Atorvastatin, Bromfenac , Carbamazepine, Chaparral, Chelidonium, Ciprofloxacin, Comfrey, Cyclophosphamide, Dantrolene, Dapsone, Didanosine, Dideoxyinosine, Disulfiram, Doxycycline, Efavirenz, Ephedra, Erlotinib, Erythromycin, Etodolac, Fluoroquinolones, Flutamide, Gemtuzumab, Gemtuzumab, Germander tea, Ginseng, Halothane, He Shou Wu, Imipramine, Interferon beta, Isoflurane, Isoniazid, Kava kava, Ketoconazole, Labetalol, Leflunomide, Lovastatin, Ma Huang, MAO inhibitors, Methotrexate, Methyldopa, Moxifloxacin, Nevirapine, Nicotinic acid, Nitisinone, Nitrofurantoin, Nortriptyline, NSAIDs, Oral contraceptive pills , Pazopanib, Pemoline, Pennyroyal, Phenytoin, Propylthiouracil, Pyrazinamide, Regorafenib, Rifampin, Simvastatin, Skull cap, Statins, Sulfasalazine, Suloctidil, Terbinafine, Tetracycline, Teucrium polium, Tolcapone, Tricyclic antidepressants, Troglitazone, Valproic acid, Ecstacy, Cocaine
Psychiatric	No underlying causes
Pulmonary	Asphyxia, Alpha1-antitrypsin deficiency
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Autoimmune hepatitis, Graft versus host disease
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, Cocaine, Cryptogenic, Ecstacy, Heat stroke, Hyperthermia, Hypothermia

Causes in Alphabetical Order

3

References

↑ Ichai P, Samuel D (2008). "Etiology and prognosis of fulminant hepatitis in adults". Liver Transpl. 14 Suppl 2: S67–79. doi:10.1002/lt.21612. PMID 18825677.
↑ ^2.0 ^2.1 Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann. Intern. Med. 137 (12): 947–54. PMID 12484709.
↑ Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
↑ Wasley A, Fiore A, Bell BP (2006). "Hepatitis A in the era of vaccination". Epidemiol Rev. 28: 101–11. doi:10.1093/epirev/mxj012. PMID 16775039.
↑ Björnsson E, Olsson R (2005). "Outcome and prognostic markers in severe drug-induced liver disease". Hepatology. 42 (2): 481–9. doi:10.1002/hep.20800. PMID 16025496.

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[pmid18825677-1] Ichai P, Samuel D (2008). "Etiology and prognosis of fulminant hepatitis in adults". Liver Transpl. 14 Suppl 2: S67–79. doi:10.1002/lt.21612. PMID 18825677.

[pmid12484709-2] 2.0 ^2.1 Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann. Intern. Med. 137 (12): 947–54. PMID 12484709.

[pmid23013075-3] Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.

[pmid16775039-4] Wasley A, Fiore A, Bell BP (2006). "Hepatitis A in the era of vaccination". Epidemiol Rev. 28: 101–11. doi:10.1093/epirev/mxj012. PMID 16775039.

[pmid16025496-5] Björnsson E, Olsson R (2005). "Outcome and prognostic markers in severe drug-induced liver disease". Hepatology. 42 (2): 481–9. doi:10.1002/hep.20800. PMID 16025496.

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