Butt N, Ali S, Khemani H, Mumtaz K. Acute liver failure etiology, clinical manifestation and outcomes in adults: Experience of tertiary care hospital in Karachi. World J Crit Care Med 2025; 14(3): 105428 [PMID: 40880569 DOI: 10.5492/wjccm.v14.i3.105428]
Corresponding Author of This Article
Nazish Butt, Associate Professor, Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Rafiqui, Sarwar Shaheed Rd, Karachi Cantonment, Karachi 05444, Pakistan. dr.nazishbutt@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sep 9, 2025 (publication date) through Mar 6, 2026
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Journal Information of This Article
Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Butt N, Ali S, Khemani H, Mumtaz K. Acute liver failure etiology, clinical manifestation and outcomes in adults: Experience of tertiary care hospital in Karachi. World J Crit Care Med 2025; 14(3): 105428 [PMID: 40880569 DOI: 10.5492/wjccm.v14.i3.105428]
Nazish Butt, Sabir Ali, Hanisha Khemani, Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 05444, Pakistan
Khalid Mumtaz, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Butt N contributed to the conception and design of work; Ali S contributed to the acquisition, analysis and interpretation of data; Khemani H drafted the work and Mumtaz K final approved of the version and agreement to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated and resolved.
Institutional review board statement: The study was approved by Jinnah Post Graduate Medical Centre (No: F.2-81/2019-GENIL/35813/JPMC).
Clinical trial registration statement: As it does not involve an interventional trial, clinical trial registration is not required.
Informed consent statement: Consent was taken from the subjects before collecting the data from them.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data supporting the findings of this study will be made available upon reasonable request from the corresponding author.
Corresponding author: Nazish Butt, Associate Professor, Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Rafiqui, Sarwar Shaheed Rd, Karachi Cantonment, Karachi 05444, Pakistan. dr.nazishbutt@gmail.com
Received: January 22, 2025 Revised: March 15, 2025 Accepted: April 1, 2025 Published online: September 9, 2025 Processing time: 178 Days and 6.1 Hours
Abstract
BACKGROUND
Many causal factors influence acute liver failure (ALF), including the primary underlying cause, age, and socioeconomic conditions. ALF outcomes depend on etiology, coagulopathy, bilirubin, age, and understanding of hepatic encephalopathy (HE), and help us predict coma and death.
AIM
To evaluate the association between etiologies, clinical manifestations, and outcomes of adults admitted with ALF.
METHODS
This institution-based, prospective cross-sectional study was conducted in the Department of Gastroenterology and Hepatology at Jinnah Postgraduate Medical Center, Karachi, from July 2019 to December 2022. A total of 102 patients diagnosed with ALF were included using consecutive sampling and data were collected from patients who visited Jinnah Postgraduate Medical Center, Karachi, the gastroenterology and hepatology department, entered into Microsoft Excel, and analyzed using Statistical Package for the Social Sciences version 26.0. Diagnosis was based on King’s College criteria: Age, encephalopathy grade, bilirubin, prothrombin time, international normalized ratio, creatinine, and etiology. We assessed the association between socioeconomic status and various outcomes using chi-square tests with a level of significance was less than 0.05.
RESULTS
Mean age of the ALF cohort was 27.37 ± 6.60 years. Of the 102 patients, 71 (69.6%) were female, including 55 (77.5%) pregnant women with a mean gestational age of 34.56 ± 3.80 weeks. Regarding HE severity, 45 (44.1%) had grade III, and 13 (12.7%) had grade II. Among the patients admitted to the intensive care unit, 51 (72.9%) did not survive, while 14 (43.8%) recovered.
CONCLUSION
This study observed a high mortality rate among ALF patients in a tertiary care hospital. Hepatitis E virus infection, HE severity, and sepsis were significantly associated with higher mortality.
Core Tip: This study investigates the etiological factors, clinical manifestations, and outcomes of acute liver failure in a tertiary care hospital in Pakistan. Hepatitis E virus was the predominant cause, particularly in pregnant women, with high associated mortality. Jaundice, hepatic encephalopathy, sepsis, and fatigue were significant predictors of poor prognosis. Limited liver transplant facilities contribute to increased mortality, highlighting the urgent need for early referral, risk factor management, and improved supportive care to enhance patient survival.
