Acute liver injury and acute liver failure from mushroom poisoning in North America

the United States Acute Liver Failure Study Group

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background & Aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46%), five survived with LT (39%) and two died without LT (15%). Of the five patients with ALI, four (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (P > 0.15 for all therapies). Conclusion: Patients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.

Original languageEnglish (US)
Pages (from-to)1043-1050
Number of pages8
JournalLiver International
Volume36
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Mushroom Poisoning
Acute Liver Failure
North America
Transplants
Liver
Wounds and Injuries
Survivors
Survival
Registries
International Normalized Ratio
Agaricales
Acetylcysteine
Bilirubin
Penicillins
Drainage
Lactic Acid
Cohort Studies
Therapeutics

Keywords

  • Amanita phalloides
  • acute liver failure
  • acute liver injury
  • fulminant hepatic failure
  • liver transplantation
  • mushroom toxicity

ASJC Scopus subject areas

  • Hepatology

Cite this

Acute liver injury and acute liver failure from mushroom poisoning in North America. / the United States Acute Liver Failure Study Group.

In: Liver International, Vol. 36, No. 7, 01.07.2016, p. 1043-1050.

Research output: Contribution to journalArticle

the United States Acute Liver Failure Study Group 2016, 'Acute liver injury and acute liver failure from mushroom poisoning in North America', Liver International, vol. 36, no. 7, pp. 1043-1050. https://doi.org/10.1111/liv.13080
the United States Acute Liver Failure Study Group. / Acute liver injury and acute liver failure from mushroom poisoning in North America. In: Liver International. 2016 ; Vol. 36, No. 7. pp. 1043-1050.
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abstract = "Background & Aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of the 2224 subjects in the registry, 18 (0.8{\%}) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46{\%}), five survived with LT (39{\%}) and two died without LT (15{\%}). Of the five patients with ALI, four (80{\%}) recovered and one (20{\%}) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88{\%} vs. SS 80{\%}); whereas, silibinin (25{\%} vs. 50{\%}), penicillin (50{\%} vs. 25{\%}) and nasobiliary drainage (0 vs. 10{\%}) were used less frequently (P > 0.15 for all therapies). Conclusion: Patients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.",
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T1 - Acute liver injury and acute liver failure from mushroom poisoning in North America

AU - the United States Acute Liver Failure Study Group

AU - Karvellas, Constantine J.

AU - Tillman, Holly

AU - Leung, Alexander A.

AU - Lee, William M.

AU - Schilsky, Michael L.

AU - Hameed, Bilal

AU - Stravitz, R. Todd

AU - McGuire, Brendan M.

AU - Fix, Oren K.

AU - Lee, W. M.

AU - Larson, Anne M.

AU - Liou, Iris

AU - Fix, Oren

AU - Schilsky, Michael

AU - McCashland, Timothy

AU - McCashland, Timothy M

AU - Murray, Natalie

AU - Obaid, A.

AU - Shaikh, S.

AU - Blei, Andres

AU - Ganger, Daniel

AU - Zaman, Atif

AU - Han, Steven H B

AU - Fontana, Robert

AU - McGuire, Brendan

AU - Chung, Raymond T.

AU - Smith, Alastair

AU - Brown, Robert

AU - Crippin, Jeffrey

AU - Harrison, Edwin

AU - Reuben, Adrian

AU - Munoz, Santiago

AU - Reddy, Rajender

AU - Rossaro, Lorenzo

AU - Satyanarayana, Raj

AU - Hassanein, Tarek

AU - Olson, Jodi

AU - Subramanian, Ram

AU - Hanje, James

AU - Samuel, Grace

AU - Lalani, Ezmina

AU - Pezzia, Carla

AU - Sanders, Corron

AU - Attar, Nahid

AU - Hynan, Linda S.

AU - Durkalski, Valerie

AU - Zhao, Wenle

AU - Speiser, Jaime

AU - Dillon, Catherine

AU - Battenhouse, Holly

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background & Aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46%), five survived with LT (39%) and two died without LT (15%). Of the five patients with ALI, four (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (P > 0.15 for all therapies). Conclusion: Patients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.

AB - Background & Aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Results: Of the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 μm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46%), five survived with LT (39%) and two died without LT (15%). Of the five patients with ALI, four (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (P > 0.15 for all therapies). Conclusion: Patients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.

KW - Amanita phalloides

KW - acute liver failure

KW - acute liver injury

KW - fulminant hepatic failure

KW - liver transplantation

KW - mushroom toxicity

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