Drug-induced and indeterminate acute liver failure (ALF) might be due to an autoimmune-like hepatitis that is responsive to corticosteroid therapy. The aim of this study was to evaluate whether corticosteroids improve survival in fulminant autoimmune hepatitis, drug-induced, or indeterminate ALF, and whether this benefit varies according to the severity of illness. We conducted a retrospective analysis of autoimmune, indeterminate, and drug-induced ALF patients in the Acute Liver Failure Study Group from 1998-2007. The primary endpoints were overall and spontaneous survival (SS, survival without transplant). In all, 361 ALF patients were studied, 66 with autoimmune (25 steroids, 41 no steroids), 164 with indeterminate (21 steroids, 143 no steroids), and 131 with drug-induced (16 steroids, 115 no steroids) ALF. Steroid use was not associated with improved overall survival (61% versus 66%, P = ), nor with improved survival in any diagnosis category. Steroid use was associated with diminished survival in certain subgroups of patients, including those with the highest quartile of the Model for Endstage Liver Disease (MELD) (>40, survival 30% versus 57%, P = ). In multivariate analysis controlling for steroid use and diagnosis, age (odds ratio [OR] per decade), coma grade (OR grade 2, grade 3, grade 4), MELD (OR ), and pH < (OR ) were significantly associated with mortality. Although steroid use was associated with a marginal benefit in SS overall (35% versus 23%, P = ), this benefit did not persistent in multivariate analysis; mechanical ventilation (OR ), MELD (OR ), and alanine aminotransferase () were the only significant predictors of SS. Conclusion : Corticosteroids did not improve overall survival or SS in drug-induced, indeterminate, or autoimmune ALF and were associated with lower survival in patients with the highest MELD scores. (H epatology 2014;59:612–621)
Dietary therapy plays an important role in managing copper associated liver disease. The ideal food is low in copper, high in zinc, high in B-vitamins (which are often deficient with liver disease), and contains adequate but not excessive amounts of high quality protein since eating too much protein can adversely affect brain function in dogs with liver disease. The diets should be tasty enough to encourage dogs to eat and nutrient dense so that pets with marginal appetites don’t have to take in large volumes. Feeding multiple meals throughout the day is often necessary to maintain a dog’s body condition.