Acute liver failure (ALF) is a critical illness whose study and treatment is complicated by its rarity, severity and phenotypic heterogeneity. For many years the cause of ALF has been recognised as a key determinant of its principal clinical manifestations and the course that a patient will follow. Different etiologies are recognised as prognostically ‘favourable’ or ‘unfavourable’ and integrated into systems used to predict outcome with medical supportive care alone, and to identify candidates for liver transplantation (LT) ^{1 2}. These differences are illustrated by the variation of different forms of drug-induced ALF. Patients with illness from ‘unfavorable’ idiosyncratic drug-induced liver injury (DILI) often have slow onset of illness and evolution of encephalopathy, only moderate coagulopathy but marked jaundice and often a very poor survival with medical supportive care alone. By contrast, those with ‘favourable’ acetaminophen (APAP) induced ALF, usually occurring after overdose, have illness typically characterised by very rapid onset of disease, minimal jaundice but major coagulopathy, severe multi-organ failure and encephalopathy with – at least historically - the development of cerebral edema (CE) and intra-cranial hypertension (ICH). Despite this severity of illness, recovery with medical care alone is much more likely than in unfavourable etiologies.

中文翻译：

---

移植候补名单上的 ALF：对乙酰氨基酚是好是坏？

急性肝衰竭 (ALF) 是一种危重疾病，其研究和治疗因其罕见性、严重性和表型异质性而变得复杂。多年来，ALF 的病因一直被认为是其主要临床表现和患者病程的关键决定因素。不同的病因被认为是预后“有利”或“不利”的，并被整合到用于预测单独医疗支持治疗结果的系统中，并确定肝移植 (LT) 的候选者 1 ². 这些差异通过不同形式的药物诱导的 ALF 的变化来说明。患有“不良”特异质药物性肝损伤 (DILI) 疾病的患者通常起病缓慢，脑病进展缓慢，只有中度凝血功能障碍但有明显黄疸，仅靠药物支持治疗往往存活率很低。相比之下，那些患有“有利的”对乙酰氨基酚 (APAP) 诱发的 ALF，通常在过量服用后发生，其疾病的典型特征是疾病发作非常迅速、黄疸轻微但凝血功能障碍严重、严重的多器官衰竭和脑病——至少在历史上是这样的——脑水肿 (CE) 和颅内高压 (ICH) 的发展。尽管疾病如此严重，但与不利的病因相比，仅通过医疗护理康复的可能性要大得多。