The following are the most important diseases or complications that may be contributed to by liver insufficiency:
Blood, blood-forming organs – Immune system (D50-D90).
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Hypoalbuminemia/hypalbuminemia (decreased concentration of the plasma protein albumin in blood plasma) with ascites (abdominal fluid).
- Hypoglycemia (hypoglycemia)
Infectious and parasitic diseases (A00-B99).
- Infections, unspecified
Liver, gallbladder, and bile ducts-pancreas (pancreas) (K70-77; K80-87).
- Acute-on-chronic liver failure (ACLF) represents acute hepatic decompensation of preexisting chronic liver disease with consecutive organ failure. Short-term survival is very poor and stage-dependent. Triggers are bacterial infections, which in this case lead to systemic inflammation (inflammation). This disease is a relatively new entity.Definiton:
- Presence of acute decompensation,
- Identification of organ failure by objectifiable standards.
- High short-term mortality of more than 15%.
- Acute liver failure (ALV; acute liver failure, ALF) [ICD-10 K72.0] – between onset and encephalopathy is between 7 and 28 days; fulminant: < 7 days, protracted > 4 weeks.
- Severe hepatic dysfunction with icterus (jaundice) and consecutive coagulopathy (INR > 1.5)
- Hepatic encephalopathy (HE; see below).
- Chronic liver failure
- Coma hepaticum (hepatic coma)
- Hepatorenal syndrome (HRS) – functional, in principle fully reversible decrease in glomerular filtration rate (total volume of primary urine at, which is filtered by all glomeruli (renal corpuscles) of both kidneys together, in a defined unit of time, filtered) resulting in oliguric renal failure (in oliguric renal failure, the kidneys output < 500 ml of urine production / day) in patients with liver cirrhosis (irreversible damage to the liver and a pronounced remodeling of liver tissue) or fulminant hepatitis (liver inflammation) in the absence of evidence of other causes of renal failure (slowly progressive reduction in renal function) [incidence in acute liver failure up to 80% of cases].
- Terminal chronic liver failure (late stage of liver cirrhosis).
Psyche – nervous system (F00-F99; G00-G99).
- Hepatic encephalopathy (HE; disease or damage to the brain; approximately 40 percent of patients with cirrhosis develop clinically noticeable HE, with another 30 to 40 percent having minimal HE)).
- Cerebral edema (swelling of the brain)
- Psychosis
Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).
- Icterus (jaundice)
- Cachexia (emaciation; very severe emaciation).
Other
- Death
Prognostic factors
Acute-on-chronic liver failure (ACLF) represents acute hepatic decompensation of preexisting chronic liver disease with consecutive organ failure. Short-term survival is very poor and stage-dependent. Triggers are bacterial infections, which in this case lead to systemic inflammation (inflammation). This disease is a relatively new entity.The Sequential Organ Assessment Score (SOFA)-see Sepsis/Classification for details-has been modified and is used to graduate ALCF into three severity levels (= CLIF-SOFA score):
| Organs/System | 0 | 1 | 2 | 3 | 4 |
| Hepatic dysfunction (bilirubin level; mg/dl) [μmol/l]. | < 1,2 | ≥ 1,2 – ≤ 1,9[> 20-32] | ≥ 2 – ≤ 5,9[33-101] | ≥ 6 – ≤ 12 | ≥ 12 [> 204] |
| Renal insufficiency (S-creatinine, mg/dl) [μmol/L] | < 1,2 | ≥ 1,2 – ≤ 1,9[110-170] | ≥ 2 – ≤ 3,5[171-299] | ≥ 3.5 – < 5(or < 500 ml/d) | ≥ 5 [> 440] |
| HE grade (according to the West Haven criteria). | No HE | 1 | 2 | 3 | 4 |
| Coagulopathy (International Normalized Ratio, INR) | < 1,1 | ≥ 1,1- ≤ 1,25 | ≥ 1,25 – ≤ 1,5 | ≥ 1,5 – ≤2,5 | ≥ 2.5 orplatelets ≤ 20 ×103/µl. |
| Circulatory dysfunction [mean arterial blood pressure (MAD) or vasopressor requirement* ] | ≥ 70 | MAD < 70 mm/Hg | Dopamine ≤ 5orDobutamine (any dose). | Dopamine > 5or epinephrine ≤ 0.1 or norepinephrine ≤ 0.1 | Dopamine > 15or epinephrine > 0.1 or norepinephrine > 0.1 |
| Oxygenation disturbance [pulse oximetry-measured partial pressure of oxygen (PaO2) oroxygen saturation (SpO2)/inspiratory oxygen fraction (FiO2) | > 400> 512 | > 330 – ≤ 400> 357 – ≤ 512 | > 200 – ≤ 300> 214 – ≤ 357 | > 100 – ≤ 200> 8 – ≤ 214 | ≤ 100≤ 89 |
* Doses of catecholamines in [µg/kg/min].
Calculator – see at: http://www.clifresearch.com/ToolsCalculators.aspx
Semiquantitative staging of mental status in hepatic encephalopathy according to West Haven criteria.
| Stage | State of consciousness | Neuropsychiatric symptoms | Neurological symptoms |
| Stage 0 = MHE | normal | Disturbance to be detected only by too biometric tests | none |
| stage 1 | Mild mental retardation | Euphoria/dysphoria, irritability and anxiety, reduced alertness | Impaired fine motor skills (impaired ability to write, finger tremor) |
| Stage 2 | Increased fatigue, apathy (listlessness), or lethargy (state in which someone has no interest in anything) | Mild personality disorder, minimal disorientation. Place and time | Flapping tremor (coarse tremor of the hands), ataxia (disturbances in movement coordination), slurred speech |
| Stage 3 | Somnolence (stage of quantitative disturbance of consciousness). | Rigor, convulsions, asterixis (gross trembling of the hands). | |
| Stage 4 | Coma | – – | Brain pressure character |
Legend: MHE = minimal hepatic encephalopathy.
