We analyzed a prospective

database of all adult patients consecutively admitted to the liver unit of our institution between January find more 2004 and June 2007. ALF was diagnosed according to the criteria of the American Association for the Study of Liver Diseases (AASLD),1 including a sudden development of severe coagulopathy with an international normalized ratio (INR) ≥1.5 and mental alteration with an illness duration no longer than 26 weeks. Patients with underlying chronic diseases such as chronic hepatitis B (CHB) and autoimmune hepatitis (AIH) were included if they had normal liver function before the onset of symptoms and there was www.selleckchem.com/products/ulixertinib-bvd-523-vrt752271.html no evidence of cirrhosis. Informed

consent was obtained from each patient’s next of kin, and the study was approved by the Institutional Review Board of the Asan Medical Center. All patients underwent standardized evaluation to determine the cause of liver injury. This included a detailed review of medications, herbal remedies, and exposure to toxins; assays for hepatitis B surface antigen (HBsAg), anti-hepatitis B core (IgM), anti-hepatitis A virus (IgM), anti-hepatitis C virus, and anti-hepatitis E virus (IgM) antibodies; serologic tests with or without polymerase chain reaction (PCR) quantification of cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes

simplex virus, and human immunodeficiency virus; assays for antinuclear and anti–smooth muscle antibodies; serum ceruloplasmin and 24-hour urine copper quantification; and liver imaging, including dynamic contrast-enhanced computed tomography (CT). Drug-induced or herb-induced ALF was diagnosed when a temporal relationship between exposure to a suspected agent and the onset of ALF was identified and other causes of ALF were excluded. APAP was presumed as the cause of ALF when there was a history MCE公司 of potentially toxic APAP ingestion (>4 g/day) within 7 days of presentation. Patients were diagnosed as having ALF attributable to other drugs or herbs by use of the Roussel Uclaf Causality Assessment Method (RUCAM)10 or a locally developed scale for assessment of phyto-hepatotoxicity (a modified RUCAM).11 AIH was diagnosed using the criteria of the International Autoimmune Hepatitis Group.12 ALF was classified as “indeterminate” when supporting evidence of a specific etiology could not be established despite extensive investigation.