Previous retrospective study (1992 to 2000) performed in Spain showed that drug toxicity, viral hepatitis, and indeterminate etiology were the most prevalent causes of acute liver failure (ALF). In the last decade, there is no information about ALF in our country. For these reasons we analyze retrospectively, in a ten-year period (2000 to 2010), the presumed causes, clinical characteristics, course, and outcome of ALF in a Spanish community. Causes of ALF were indeterminate in 4 patients (24%), acute hepatitis B infection in 4 patients (24%), drug or toxic reactions in 4 patients (24%), including one case of acetaminophen overdose, followed by miscellaneous causes. The overall short-term survival (6 weeks after admission) was 65%. Liver transplantation was performed in 11 patients with a survival of 82%. Despite fulfilling criteria, 2 patients were not transplanted because of contraindications; they both died. In summary, acute hepatitis B and indeterminate cause are still being the most frequent causes of ALF in our region, and patients with ALF have an excellent chance of survival after emergency liver transplantation. Acetaminophen overdose still represents a very rare cause of ALF in our community. 1. Introduction Acute liver failure (ALF) is a clinical syndrome, in which there is an acute insult in a patient without a known preexisting liver disease that leads to a rapid loss of liver function, characterized mainly by hepatic encephalopathy (HE), jaundice and coagulopathy [1]. The prognosis of these patients was very poor until the introduction of liver transplantation (LT) for the treatment of this disease in the last decades, improving their survival significantly [1, 2]. Current results of LT are very good considering the natural history of the disease, the multiorgan involvement, the emergency context, and the lack of other effective therapies [3]. An important aspect of ALF that needs further clarification is the varying composition of ALF causes among different geographic regions [2, 4]. One retrospective study from Spain summarized 267 ALF cases observed from 1992 to 2000 [5]. Our center participated in this study and drug toxicity, viral hepatitis and indeterminate etiology were the most prevalent causes of ALF [5]. In the last decade, there are no published studies about ALF in our country. For that reason, in our hospital, we decided to determine retrospectively if in the last ten years there have been changes in the etiology, clinical course, and outcome in patients with ALF. 2. Patients and Methods 2.1. Enrollment of Patients and
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