A Multi-Center Trial to Study Acute Liver Failure in Adults

Acute Liver Failure Clinical Trial

— ALFSG  

Official title:

A Multi-Center Trial to Study Acute Liver Failure in Adults

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00518440
• Other study ID #: STU 062010-126
• Secondary ID: 2U01DK058369
• Status: Completed
• Start date: January 1998
• Est. completion date: September 18, 2019

Study information

• Verified date: January 2022
• Source: University of Texas Southwestern Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The purpose of this study is to collect clinical and epidemiological data as well as serum, plasma, urine, tissue and DNA samples on individuals who have acute liver failure and on individuals who have acute liver injury, a less severe group of patients who have coagulopathy but do not reach the threshold of encephalopathy.

Description:

Although ALF is truly an orphan disease affecting only about 2,000 persons per year, its severity, its frequency among young adults, and its high resource utilization justifies the attention paid to it. In addition, ALF has captured the interest and attention of researchers because of its unique pathogenesis and extreme severity, encouraging us to understand the processes underlying all forms of liver injury, by focusing on this most lethal manifestation.

The etiologies associated with ALF have continued to change further over the years with an apparent decline in viral hepatitis, and a remarkable increase in acetaminophen toxicity to its current level of ~44-50% of cases. A further problem in studying ALF is that the number of cases of a specific etiology observed at any one institution are vanishingly small. The earliest goals of the ALF Study then were to more carefully define the etiologies of ALF on a national scale, and to finally allow in-depth study of specific ALF causes such as autoimmune ALF, viral hepatitis and Wilson disease (WD).

A second group of patients worthy of study are those with acute liver injury.It would be of value to study patients destined to possibly have ALF earlier in their illness for several reasons: first, we might be able to better predict who will progress to full liver failure; second, the current definition requiring encephalopathy limits the number of patients available for study at any site; finally, therapeutic trials might have greater efficacy if begun at earlier disease stages.

Patients who are enrolled are referred to ALFSG clinical sites by gastroenterologist/hepatologist and fellows. Detailed clinical data and bio-specimen (sera, urine, plasma, DNA and tissue if available) are collected. Subjects are followed long-term at 6 months and 12 months. Detailed clinical data and sera are collected.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3488
• Est. completion date: September 18, 2019
• Est. primary completion date: September 18, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

ALF Inclusion Criteria:

• Written Informed consent from patient's next of kin

• Altered mentation of any degree (encephalopathy)

• Evidence of moderately severe coagulopathy (INR = 1.5)

• A presumed acute illness onset of less than 26 weeks

• The NIH guidelines on the inclusion of women and minorities as subjects in clinical research will be observed

ALF Exclusion Criteria:

• Cirrhosis patients

• Alcohol induced liver failure

• Known pre-existing chronic liver disease

ALI Inclusion Criteria:

Acetaminophen (APAP) etiology: acute illness < 2 wks

• INR = 2.0, ALT = 10X ULN Non-acetaminophen etiology: acute illness < 26 wks

• INR= 2.0, ALT= 10X ULN, TBili = 3 mg/dl

ALI Exclusion Criteria:

• Altered mentation of any degree (encephalopathy)

Related Conditions & MeSH terms

• Acute Liver Failure
• Acute Liver Injury
• Fulminant Hepatic Failure
• Hepatic Insufficiency
• Liver Failure
• Liver Failure, Acute

Locations

Country	Name	City	State
Canada	University of Alberta	Edmonton	Alberta
United States	University of Michigan Medical Center	Ann Arbor	Michigan
United States	University of Alabama at Birmingham	Birmingham	Alabama
United States	Medical University of South Carolina	Charleston	South Carolina
United States	Northwestern University Medical School	Chicago	Illinois
United States	The Ohio State University	Columbus	Ohio
United States	University of Texas Southwestern Medical Center	Dallas	Texas
United States	Kansas University Medical Center	Kansas City	Kansas
United States	Yale Medical School	New Haven	Connecticut
United States	Virginia Commonwealth University	Richmond	Virginia
United States	University of California, San Francisco	San Francisco	California
United States	University of Washington	Seattle	Washington

Sponsors (2)

Lead Sponsor	Collaborator
William Lee	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Countries where clinical trial is conducted

United States,  Canada, 

References & Publications (87)

Ajmera V, Xia G, Vaughan G, Forbi JC, Ganova-Raeva LM, Khudyakov Y, Opio CK, Taylor R, Restrepo R, Munoz S, Fontana RJ, Lee WM; Acute Liver Failure Study Group. What factors determine the severity of hepatitis A-related acute liver failure? J Viral Hepat. — View Citation

Basta G, Del Turco S, Navarra T, Lee WM; Acute Liver Failure Study Group. Circulating levels of soluble receptor for advanced glycation end products and ligands of the receptor for advanced glycation end products in patients with acute liver failure. Live — View Citation

Chung RT, Stravitz RT, Fontana RJ, Schiodt FV, Mehal WZ, Reddy KR, Lee WM. Pathogenesis of liver injury in acute liver failure. Gastroenterology. 2012 Sep;143(3):e1-e7. doi: 10.1053/j.gastro.2012.07.011. Epub 2012 Jul 13. — View Citation

Coté GA, Gottstein JH, Daud A, Blei AT; Acute Liver Failure Study Group. The role of etiology in the hyperamylasemia of acute liver failure. Am J Gastroenterol. 2009 Mar;104(3):592-7. doi: 10.1038/ajg.2008.84. Epub 2009 Feb 17. — View Citation

Court MH, Freytsis M, Wang X, Peter I, Guillemette C, Hazarika S, Duan SX, Greenblatt DJ, Lee WM; Acute Liver Failure Study Group. The UDP-glucuronosyltransferase (UGT) 1A polymorphism c.2042C>G (rs8330) is associated with increased human liver acetaminop — View Citation

Court MH, Peter I, Hazarika S, Vasiadi M, Greenblatt DJ, Lee WM; Acute Liver Failure Study Group. Candidate gene polymorphisms in patients with acetaminophen-induced acute liver failure. Drug Metab Dispos. 2014 Jan;42(1):28-32. doi: 10.1124/dmd.113.053546 — View Citation

Dao DY, Hynan LS, Yuan HJ, Sanders C, Balko J, Attar N, Lok AS, Word RA, Lee WM; Acute Liver Failure Study Group. Two distinct subtypes of hepatitis B virus-related acute liver failure are separable by quantitative serum immunoglobulin M anti-hepatitis B — View Citation

Dao DY, Seremba E, Ajmera V, Sanders C, Hynan LS, Lee WM; Acute Liver Failure Study Group. Use of nucleoside (tide) analogues in patients with hepatitis B-related acute liver failure. Dig Dis Sci. 2012 May;57(5):1349-57. doi: 10.1007/s10620-011-2013-3. Ep — View Citation

Davern TJ 2nd, James LP, Hinson JA, Polson J, Larson AM, Fontana RJ, Lalani E, Munoz S, Shakil AO, Lee WM; Acute Liver Failure Study Group. Measurement of serum acetaminophen-protein adducts in patients with acute liver failure. Gastroenterology. 2006 Mar — View Citation

Dubin PH, Yuan H, Devine RK, Hynan LS, Jain MK, Lee WM; Acute Liver Failure Study Group. Micro-RNA-122 levels in acute liver failure and chronic hepatitis C. J Med Virol. 2014 Sep;86(9):1507-14. doi: 10.1002/jmv.23987. Epub 2014 Jun 4. — View Citation

Fix OK, Liou I, Karvellas CJ, Ganger DR, Forde KA, Subramanian RM, Boylan A, Hanje J, Stravitz RT, Lee WM; Acute Liver Failure Study Group. Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit. PLoS One. 20 — View Citation

Fontana RJ, Ellerbe C, Durkalski VE, Rangnekar A, Reddy RK, Stravitz T, McGuire B, Davern T, Reuben A, Liou I, Fix O, Ganger DR, Chung RT, Schilsky M, Han S, Hynan LS, Sanders C, Lee WM; US Acute Liver Failure Study Group. Two-year outcomes in initial sur — View Citation

Fontana RJ, Engle RE, Scaglione S, Araya V, Shaikh O, Tillman H, Attar N, Purcell RH, Lee WM; US Acute Liver Failure Study Group. The role of hepatitis E virus infection in adult Americans with acute liver failure. Hepatology. 2016 Dec;64(6):1870-1880. do — View Citation

Fontana RJ, McCashland TM, Benner KG, Appelman HD, Gunartanam NT, Wisecarver JL, Rabkin JM, Lee WM. Acute liver failure associated with prolonged use of bromfenac leading to liver transplantation. The Acute Liver Failure Study Group. Liver Transpl Surg. 1 — View Citation

Fontana RJ, Shakil AO, Greenson JK, Boyd I, Lee WM. Acute liver failure due to amoxicillin and amoxicillin/clavulanate. Dig Dis Sci. 2005 Oct;50(10):1785-90. Review. — View Citation

Forde KA, Reddy KR, Troxel AB, Sanders CM, Lee WM; Acute Liver Failure Study Group. Racial and ethnic differences in presentation, etiology, and outcomes of acute liver failure in the United States. Clin Gastroenterol Hepatol. 2009 Oct;7(10):1121-6. doi: — View Citation

Foureau DM, Walling TL, Maddukuri V, Anderson W, Culbreath K, Kleiner DE, Ahrens WA, Jacobs C, Watkins PB, Fontana RJ, Chalasani N, Talwalkar J, Lee WM, Stolz A, Serrano J, Bonkovsky HL. Comparative analysis of portal hepatic infiltrating leucocytes in ac — View Citation

Gregory B, Larson AM, Reisch J, Lee WM; Acute Liver Failure Study Group. Acetaminophen dose does not predict outcome in acetaminophen-induced acute liver failure. J Investig Med. 2010 Jun;58(5):707-10. doi: 10.231/JIM.0b013e3181db8764. — View Citation

Hillman L, Gottfried M, Whitsett M, Rakela J, Schilsky M, Lee WM, Ganger D. Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury. Am J Gastroenterol. 2016 Jul;111(7):958-65. doi: 10.1038/ajg.2016. — View Citation

James LP, Alonso EM, Hynan LS, Hinson JA, Davern TJ, Lee WM, Squires RH; Pediatric Acute Liver Failure Study Group. Detection of acetaminophen protein adducts in children with acute liver failure of indeterminate cause. Pediatrics. 2006 Sep;118(3):e676-81 — View Citation

James LP, Letzig L, Simpson PM, Capparelli E, Roberts DW, Hinson JA, Davern TJ, Lee WM. Pharmacokinetics of acetaminophen-protein adducts in adults with acetaminophen overdose and acute liver failure. Drug Metab Dispos. 2009 Aug;37(8):1779-84. doi: 10.112 — View Citation

Karkhanis J, Verna EC, Chang MS, Stravitz RT, Schilsky M, Lee WM, Brown RS Jr; Acute Liver Failure Study Group. Steroid use in acute liver failure. Hepatology. 2014 Feb;59(2):612-21. doi: 10.1002/hep.26678. Epub 2013 Dec 24. — View Citation

Karvellas CJ, Cavazos J, Battenhouse H, Durkalski V, Balko J, Sanders C, Lee WM; US Acute Liver Failure Study Group. Effects of antimicrobial prophylaxis and blood stream infections in patients with acute liver failure: a retrospective cohort study. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1942-9.e1. doi: 10.1016/j.cgh.2014.03.011. Epub 2014 Mar 25. — View Citation

Karvellas CJ, Fix OK, Battenhouse H, Durkalski V, Sanders C, Lee WM; U S Acute Liver Failure Study Group. Outcomes and complications of intracranial pressure monitoring in acute liver failure: a retrospective cohort study. Crit Care Med. 2014 May;42(5):11 — View Citation

Karvellas CJ, Tillman H, Leung AA, Lee WM, Schilsky ML, Hameed B, Stravitz RT, McGuire BM, Fix OK; United States Acute Liver Failure Study Group. Acute liver injury and acute liver failure from mushroom poisoning in North America. Liver Int. 2016 Jul;36(7 — View Citation

Karvellas CJ, Todd Stravitz R, Battenhouse H, Lee WM, Schilsky ML; US Acute Liver Failure Study Group. Therapeutic hypothermia in acute liver failure: a multicenter retrospective cohort analysis. Liver Transpl. 2015 Jan;21(1):4-12. doi: 10.1002/lt.24021. — View Citation

Kaur G, Leslie EM, Tillman H, Lee WM, Swanlund DP, Karvellas CJ; US Acute Liver Failure Study Group. Detection of Ophthalmic Acid in Serum from Acetaminophen-Induced Acute Liver Failure Patients Is More Frequent in Non-Survivors. PLoS One. 2015 Sep 25;10( — View Citation

Khandelwal N, James LP, Sanders C, Larson AM, Lee WM; Acute Liver Failure Study Group. Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure. Hepatology. 2011 Feb;53(2):567-76. doi: 10.1002/hep.24060. Epub 2011 Jan 10. — View Citation

Koch DG, Tillman H, Durkalski V, Lee WM, Reuben A. Development of a Model to Predict Transplant-free Survival of Patients With Acute Liver Failure. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1199-1206.e2. doi: 10.1016/j.cgh.2016.03.046. Epub 2016 Apr 13. — View Citation

Korman JD, Volenberg I, Balko J, Webster J, Schiodt FV, Squires RH Jr, Fontana RJ, Lee WM, Schilsky ML; Pediatric and Adult Acute Liver Failure Study Groups. Screening for Wilson disease in acute liver failure: a comparison of currently available diagnost — View Citation

Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiødt FV, Ostapowicz G, Shakil AO, Lee WM; Acute Liver Failure Study Group. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. — View Citation

Laursen TL, Sandahl TD, Støy S, Schiødt FV, Lee WM, Vilstrup H, Thiel S, Grønbaek H; US Acute Liver Failure Study Group. Circulating mannan-binding lectin, M-, L-, H-ficolin and collectin-liver-1 levels in patients with acute liver failure. Liver Int. 201 — View Citation

Lee WM, Brown KE, Young NS, Dawson GJ, Schlauder GG, Gutierrez RA, Fontana R, Rossaro L, Davern T, Lalani E; Acute Liver Failure Study Group. Brief report: no evidence for parvovirus B19 or hepatitis E virus as a cause of acute liver failure. Dig Dis Sci. — View Citation

Lee WM, Hynan LS, Rossaro L, Fontana RJ, Stravitz RT, Larson AM, Davern TJ 2nd, Murray NG, McCashland T, Reisch JS, Robuck PR; Acute Liver Failure Study Group. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen — View Citation

Lee WM, Squires RH Jr, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: Summary of a workshop. Hepatology. 2008 Apr;47(4):1401-15. doi: 10.1002/hep.22177. — View Citation

Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology. 2012 Mar;55(3):965-7. doi: 10.1002/hep.25551. — View Citation

Lee WM. Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology. 2004 Jul;40(1):6-9. Review. — View Citation

Lee WM. Acute liver failure in the United States. Semin Liver Dis. 2003 Aug;23(3):217-26. Review. — View Citation

Leung PS, Rossaro L, Davis PA, Park O, Tanaka A, Kikuchi K, Miyakawa H, Norman GL, Lee W, Gershwin ME; Acute Liver Failure Study Group. Antimitochondrial antibodies in acute liver failure: implications for primary biliary cirrhosis. Hepatology. 2007 Nov;4 — View Citation

Levitsky J, Duddempudi AT, Lakeman FD, Whitley RJ, Luby JP, Lee WM, Fontana RJ, Blei AT, Ison MG; US Acute Liver Failure Study Group. Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transpl. 2008 Oct;14( — View Citation

Li J, Zhu X, Liu F, Cai P, Sanders C, Lee WM, Uetrecht J. Cytokine and autoantibody patterns in acute liver failure. J Immunotoxicol. 2010 Jul-Sep;7(3):157-64. doi: 10.3109/15476910903501748. — View Citation

Long D, Fix OK, Deng X, Seielstad M, Lauring AS; Acute Liver Failure Study Group. Whole genome sequencing to identify host genetic risk factors for severe outcomes of hepatitis a virus infection. J Med Virol. 2014 Oct;86(10):1661-8. doi: 10.1002/jmv.24007 — View Citation

McGill MR, Staggs VS, Sharpe MR, Lee WM, Jaeschke H; Acute Liver Failure Study Group. Serum mitochondrial biomarkers and damage-associated molecular patterns are higher in acetaminophen overdose patients with poor outcome. Hepatology. 2014 Oct;60(4):1336- — View Citation

Mellinger JL, Rossaro L, Naugler WE, Nadig SN, Appelman H, Lee WM, Fontana RJ. Epstein-Barr virus (EBV) related acute liver failure: a case series from the US Acute Liver Failure Study Group. Dig Dis Sci. 2014 Jul;59(7):1630-7. doi: 10.1007/s10620-014-302 — View Citation

Metushi IG, Sanders C; Acute Liver Study Group, Lee WM, Uetrecht J. Detection of anti-isoniazid and anti-cytochrome P450 antibodies in patients with isoniazid-induced liver failure. Hepatology. 2014 Mar;59(3):1084-93. doi: 10.1002/hep.26564. Epub 2014 Jan 27. — View Citation

Møller HJ, Grønbaek H, Schiødt FV, Holland-Fischer P, Schilsky M, Munoz S, Hassanein T, Lee WM; U.S. Acute Liver Failure Study Group. Soluble CD163 from activated macrophages predicts mortality in acute liver failure. J Hepatol. 2007 Nov;47(5):671-6. Epub — View Citation

Murphy EJ, Davern TJ, Shakil AO, Shick L, Masharani U, Chow H, Freise C, Lee WM, Bass NM. Troglitazone-induced fulminant hepatic failure. Acute Liver Failure Study Group. Dig Dis Sci. 2000 Mar;45(3):549-53. — View Citation

Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM; U.S. Acute Liver Failure Study Group. Results of a prospective study of acute liver failure at 1 — View Citation

Parekh NK, Hynan LS, De Lemos J, Lee WM; Acute Liver Failure Study Group. Elevated troponin I levels in acute liver failure: is myocardial injury an integral part of acute liver failure? Hepatology. 2007 Jun;45(6):1489-95. — View Citation

Polson J, Wians FH Jr, Orsulak P, Fuller D, Murray NG, Koff JM, Khan AI, Balko JA, Hynan LS, Lee WM; Acute Liver Failure Study Group. False positive acetaminophen concentrations in patients with liver injury. Clin Chim Acta. 2008 May;391(1-2):24-30. doi: — View Citation

Rangnekar AS, Ellerbe C, Durkalski V, McGuire B, Lee WM, Fontana RJ. Quality of life is significantly impaired in long-term survivors of acute liver failure and particularly in acetaminophen-overdose patients. Liver Transpl. 2013 Sep;19(9):991-1000. doi: — View Citation

Reddy KR, Ellerbe C, Schilsky M, Stravitz RT, Fontana RJ, Durkalski V, Lee WM; Acute Liver Failure Study Group. Determinants of outcome among patients with acute liver failure listed for liver transplantation in the United States. Liver Transpl. 2016 Apr; — View Citation

Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010 Dec;52(6):2065-76. doi: 10.1002/hep.23937. Epub 2010 Oct 14. — View Citation

Reuben A, Tillman H, Fontana RJ, Davern T, McGuire B, Stravitz RT, Durkalski V, Larson AM, Liou I, Fix O, Schilsky M, McCashland T, Hay JE, Murray N, Shaikh OS, Ganger D, Zaman A, Han SB, Chung RT, Smith A, Brown R, Crippin J, Harrison ME, Koch D, Munoz S — View Citation

Rich NE, Sanders C, Hughes RS, Fontana RJ, Stravitz RT, Fix O, Han SH, Naugler WE, Zaman A, Lee WM. Malignant infiltration of the liver presenting as acute liver failure. Clin Gastroenterol Hepatol. 2015 May;13(5):1025-8. doi: 10.1016/j.cgh.2014.09.040. E — View Citation

Rosen HR, Biggins SW, Niki T, Gralla J, Hillman H, Hirashima M, Schilsky M, Lee WM; Acute Liver Failure Study Group. Association Between Plasma Level of Galectin-9 and Survival of Patients With Drug-Induced Acute Liver Failure. Clin Gastroenterol Hepatol. — View Citation

Rule JA, Hynan LS, Attar N, Sanders C, Korzun WJ, Lee WM; Acute Liver Failure Study Group. Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure. PLoS One. 2015 Sep 22;10(9):e0138566. doi: 10.1371/journal.pone.0138566. eCol — View Citation

Rutherford A, Davern T, Hay JE, Murray NG, Hassanein T, Lee WM, Chung RT; Acute Liver Failure Study Group. Influence of high body mass index on outcome in acute liver failure. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1544-9. Epub 2006 Sep 25. — View Citation

Rutherford A, King LY, Hynan LS, Vedvyas C, Lin W, Lee WM, Chung RT; ALF Study Group. Development of an accurate index for predicting outcomes of patients with acute liver failure. Gastroenterology. 2012 Nov;143(5):1237-1243. doi: 10.1053/j.gastro.2012.07 — View Citation

Rutherford AE, Hynan LS, Borges CB, Forcione DG, Blackard JT, Lin W, Gorman AR, Shaikh OS, Reuben A, Harrison E, Reddy KR, Le WM, Chung RT; ALF Study Group. Serum apoptosis markers in acute liver failure: a pilot study. Clin Gastroenterol Hepatol. 2007 De — View Citation

Schiodt FV, Atillasoy E, Shakil AO, Schiff ER, Caldwell C, Kowdley KV, Stribling R, Crippin JS, Flamm S, Somberg KA, Rosen H, McCashland TM, Hay JE, Lee WM. Etiology and outcome for 295 patients with acute liver failure in the United States. Liver Transpl Surg. 1999 Jan;5(1):29-34. — View Citation

Schiødt FV, Balko J, Schilsky M, Harrison ME, Thornton A, Lee WM; Acute Liver Failure Study Group. Thrombopoietin in acute liver failure. Hepatology. 2003 Mar;37(3):558-61. — View Citation

Schiødt FV, Bangert K, Shakil AO, McCashland T, Murray N, Hay JE, Lee WM; Acute Liver Failure Study Group. Predictive value of actin-free Gc-globulin in acute liver failure. Liver Transpl. 2007 Sep;13(9):1324-9. — View Citation

Schiødt FV, Chung RT, Schilsky ML, Hay JE, Christensen E, Lee WM; Acute Liver Failure Study Group. Outcome of acute liver failure in the elderly. Liver Transpl. 2009 Nov;15(11):1481-7. doi: 10.1002/lt.21865. — View Citation

Schiødt FV, Davern TJ, Shakil AO, McGuire B, Samuel G, Lee WM. Viral hepatitis-related acute liver failure. Am J Gastroenterol. 2003 Feb;98(2):448-53. — View Citation

Schiødt FV, Ostapowicz G, Murray N, Satyanarana R, Zaman A, Munoz S, Lee WM. Alpha-fetoprotein and prognosis in acute liver failure. Liver Transpl. 2006 Dec;12(12):1776-81. — View Citation

Schiødt FV, Rossaro L, Stravitz RT, Shakil AO, Chung RT, Lee WM; Acute Liver Failure Study Group. Gc-globulin and prognosis in acute liver failure. Liver Transpl. 2005 Oct;11(10):1223-7. — View Citation

Serper M, Wolf MS, Parikh NA, Tillman H, Lee WM, Ganger DR. Risk Factors, Clinical Presentation, and Outcomes in Overdose With Acetaminophen Alone or With Combination Products: Results From the Acute Liver Failure Study Group. J Clin Gastroenterol. 2016 J — View Citation

Singh S, Hynan LS, Lee WM; Acute Liver Failure Study Group. Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure. Dig Dis Sci. 2013 May;58( — View Citation

Speiser JL, Durkalski VL, Lee WM. Random forest classification of etiologies for an orphan disease. Stat Med. 2015 Feb 28;34(5):887-99. doi: 10.1002/sim.6351. Epub 2014 Nov 3. — View Citation

Speiser JL, Lee WM, Karvellas CJ; US Acute Liver Failure Study Group. Predicting outcome on admission and post-admission for acetaminophen-induced acute liver failure using classification and regression tree models. PLoS One. 2015 Apr 17;10(4):e0122929. d — View Citation

Srungaram P, Rule JA, Yuan HJ, Reimold A, Dahl B, Sanders C, Lee WM; Acute Liver Failure Study Group. Plasma osteopontin in acute liver failure. Cytokine. 2015 Jun;73(2):270-6. doi: 10.1016/j.cyto.2015.02.021. Epub 2015 Mar 21. — View Citation

Stravitz RT, Ellerbe C, Durkalski V, Reuben A, Lisman T, Lee WM; Acute Liver Failure Study Group. Thrombocytopenia Is Associated With Multi-organ System Failure in Patients With Acute Liver Failure. Clin Gastroenterol Hepatol. 2016 Apr;14(4):613-620.e4. d — View Citation

Stravitz RT, Lefkowitch JH, Fontana RJ, Gershwin ME, Leung PS, Sterling RK, Manns MP, Norman GL, Lee WM; Acute Liver Failure Study Group. Autoimmune acute liver failure: proposed clinical and histological criteria. Hepatology. 2011 Feb;53(2):517-26. doi: — View Citation

Stravitz RT, Lisman T, Luketic VA, Sterling RK, Puri P, Fuchs M, Ibrahim A, Lee WM, Sanyal AJ. Minimal effects of acute liver injury/acute liver failure on hemostasis as assessed by thromboelastography. J Hepatol. 2012 Jan;56(1):129-36. doi: 10.1016/j.jhe — View Citation

Stravitz RT, Sanyal AJ, Reisch J, Bajaj JS, Mirshahi F, Cheng J, Lee WM; Acute Liver Failure Study Group. Effects of N-acetylcysteine on cytokines in non-acetaminophen acute liver failure: potential mechanism of improvement in transplant-free survival. Li — View Citation

Strnad P, Zhou Q, Hanada S, Lazzeroni LC, Zhong BH, So P, Davern TJ, Lee WM; Acute Liver Failure Study Group, Omary MB. Keratin variants predispose to acute liver failure and adverse outcome: race and ethnic associations. Gastroenterology. 2010 Sep;139(3) — View Citation

Taylor RM, Davern T, Munoz S, Han SH, McGuire B, Larson AM, Hynan L, Lee WM, Fontana RJ; US Acute Liver Failure Study Group. Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes. Hepatology. 2006 Dec;44(6):1589-97 — View Citation

Taylor RM, Tujios S, Jinjuvadia K, Davern T, Shaikh OS, Han S, Chung RT, Lee WM, Fontana RJ. Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis. Dig Dis Sci. 2012 Mar;57(3):777-85. doi: 10.1007/s10620-011-1918-1. E — View Citation

Teo EK, Ostapowicz G, Hussain M, Lee WM, Fontana RJ, Lok AS; US ALF Study Group (Acute Liver Failure). Hepatitis B infection in patients with acute liver failure in the United States. Hepatology. 2001 Apr;33(4):972-6. — View Citation

The acute liver failure study group. Hepatology. 2002 Dec;36(6):1326. Review. — View Citation

Tujios SR, Hynan LS, Vazquez MA, Larson AM, Seremba E, Sanders CM, Lee WM; Acute Liver Failure Study Group. Risk factors and outcomes of acute kidney injury in patients with acute liver failure. Clin Gastroenterol Hepatol. 2015 Feb;13(2):352-9. doi: 10.10 — View Citation

Vaquero J, Fontana RJ, Larson AM, Bass NM, Davern TJ, Shakil AO, Han S, Harrison ME, Stravitz TR, Muñoz S, Brown R, Lee WM, Blei AT. Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy. Liver Transpl. 2005 Dec;11(12):1581-9. — View Citation

Vaquero J, Jordano Q, Lee WM, Blei AT; US Acute Liver Failure Study Group. Serum protein S-100b in acute liver failure: Results of the US Acute Liver Failure Study group. Liver Transpl. 2003 Aug;9(8):887-8. — View Citation

Vaquero J, Polson J, Chung C, Helenowski I, Schiodt FV, Reisch J, Lee WM, Blei AT. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 2003 Sep;125(3):755-64. — View Citation

Wai CT, Fontana RJ, Polson J, Hussain M, Shakil AO, Han SH, Davern TJ, Lee WM, Lok AS; US Acute Liver Failure Study Group. Clinical outcome and virological characteristics of hepatitis B-related acute liver failure in the United States. J Viral Hepat. 200 — View Citation

Woolbright BL, McGill MR, Staggs VS, Winefield RD, Gholami P, Olyaee M, Sharpe MR, Curry SC, Lee WM, Jaeschke H; Acute Liver Failure Study Group. Glycodeoxycholic acid levels as prognostic biomarker in acetaminophen-induced acute liver failure patients. T — View Citation

* Note: There are 87 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall Survival		1 Year

External Links

•   Acute Liver Failure Study Group website