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==Classification==
==Classification==
The 1993 classification defines three subcategories based on the severity and duration of the acute liver failure. <ref>O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. ''[[The Lancet|Lancet]] 1993;342:273-5. PMID 8101303.</ref> The importance of this method of classification is that the pace of the disease evolution strongly influences prognosis. The underlying [[etiology]] causing the development of acute liver failure is the other significant determinant in regards to prognosis.<ref name="ogredy1">{{cite journal |author=O'Grady JG |title=Acute liver failure |journal=Postgraduate medical journal |volume=81 |issue=953 |pages=148-54 |year=2005 |pmid=15749789 |doi=10.1136/pgmj.2004.026005}}</ref> This classification system is based upon the duration between onset of [[jaundice]] to onset of [[encephalopathy]].
Acute liver failure may be classified on the basis of the duration of the [[symptoms]] between the onset of [[jaundice]] to the onset of [[encephalopathy]]. The different classification systems based on the number of weeks from the appearance of jaundice to the encephalopathy are:<ref>O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. ''[[The Lancet|Lancet]] 1993;342:273-5. PMID 8101303.''</ref> <ref name="ogredy1">{{cite journal |author=O'Grady JG |title=Acute liver failure |journal=Postgraduate medical journal |volume=81 |issue=953 |pages=148-54 |year=2005 |pmid=15749789 |doi=10.1136/pgmj.2004.026005}}</ref><ref name="pmid9027947">{{cite journal |author=Williams R |title=Classification, etiology, and considerations of outcome in acute liver failure |journal=[[Seminars in Liver Disease]] |volume=16 |issue=4 |pages=343–8 |year=1996 |month=November |pmid=9027947 |doi=10.1055/s-2007-1007247 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-1007247 |accessdate=2012-10-26}}</ref><ref name="O'Grady-1993">{{Cite journal  | last1 = O'Grady | first1 = JG. | last2 = Schalm | first2 = SW. | last3 = Williams | first3 = R. | title = Acute liver failure: redefining the syndromes. | journal = Lancet | volume = 342 | issue = 8866 | pages = 273-5 | month = Jul | year = 1993 | doi =  | PMID = 8101303 }}</ref><ref name="Bernuau-1986">{{Cite journal  | last1 = Bernuau | first1 = J. | last2 = Rueff | first2 = B. | last3 = Benhamou | first3 = JP. | title = Fulminant and subfulminant liver failure: definitions and causes. | journal = Semin Liver Dis | volume = 6 | issue = 2 | pages = 97-106 | month = May | year = 1986 | doi = 10.1055/s-2008-1040593 | PMID = 3529410 }}</ref><ref name="Mochida-2008">{{Cite journal  | last1 = Mochida | first1 = S. | last2 = Nakayama | first2 = N. | last3 = Matsui | first3 = A. | last4 = Nagoshi | first4 = S. | last5 = Fujiwara | first5 = K. | title = Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis. | journal = Hepatol Res | volume = 38 | issue = 10 | pages = 970-9 | month = Oct | year = 2008 | doi = 10.1111/j.1872-034X.2008.00368.x | PMID = 18462374 }}</ref>


{|class="wikitable"
{| class="wikitable"
! Classification!! Time
! Classification system!! Duration
|-
|-
| Hyperacute|| 1 week  
| O’Grady System||
* Hyperacute  (0 - 1 week)
* Acute            ( From  2nd week - 4 weeks)
* Subacute      ( From 4th week - 12 weeks)
|-
|-
| Acute|| 1 week - 1 month
| Bernuau System||
* Fulminant      ( 0 - 2 weeks) 
* Subfulminant  ( 2 weeks - 12 weeks)
|-
|-
|Subacute || 1 week - 3 months
|Japanese System ||
|}
* Fulminant      (0 - 8 weeks)
** Acute      ( 0 - 1.5 weeks)
** Subacute ( 1.5 weeks - 8 weeks)


Acute liver failure can also be classified into fulminant or subfulminant. Both of these forms have a poor prognosis. It is based upon the duration between onset of hepatic illness, to the development of encephalopathy.<ref name="pmid9027947">{{cite journal |author=Williams R |title=Classification, etiology, and considerations of outcome in acute liver failure |journal=[[Seminars in Liver Disease]] |volume=16 |issue=4 |pages=343–8 |year=1996 |month=November |pmid=9027947 |doi=10.1055/s-2007-1007247 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-1007247 |accessdate=2012-10-26}}</ref>
* Late-Onset    ( 8 weeks - 12 weeks)
{|class="wikitable"
! Classification !! Time
|-
|Fulminant  || within 2 months
|-
|Subfulminant || within 2 months to 6 months
|}
|}
===O’Grady System===
The classification of encephalopathy according to the O’Grady system is as follows.<ref name="O'Grady-1993">{{Cite journal  | last1 = O'Grady | first1 = JG. | last2 = Schalm | first2 = SW. | last3 = Williams | first3 = R. | title = Acute liver failure: redefining the syndromes. | journal = Lancet | volume = 342 | issue = 8866 | pages = 273-5 | month = Jul | year = 1993 | doi =  | PMID = 8101303 }}</ref>
====Hyperacute====
Hyperacute encephalopathy is an encephalopathy that occurs within 7 days of onset of jaundice.
====Acute====
Acute encephalopathy is an encephalopathy that occurs within an interval of 8 to 28 days from onset of jaundice.
====Subacute====
Subacute encephalopathy is an encephalopathy that occurs within 5 to 12 weeks of onset of jaundice.
===Bernuau System===
The classification of encephalopathy according to the Bernuau system is as follows.<ref name="Bernuau-1986">{{Cite journal  | last1 = Bernuau | first1 = J. | last2 = Rueff | first2 = B. | last3 = Benhamou | first3 = JP. | title = Fulminant and subfulminant liver failure: definitions and causes. | journal = Semin Liver Dis | volume = 6 | issue = 2 | pages = 97-106 | month = May | year = 1986 | doi = 10.1055/s-2008-1040593 | PMID = 3529410 }}</ref>
====Fulminant====
Fulminant encephalopathy is an encephalopathy that occurs within 2 weeks of onset of jaundice.
====Subfulminant====
Subfulminant encephalopathy is an encephalopathy that occurs within an interval of 2 to 12 weeks from onset of jaundice.
====Japanese System====
The classification of encephalopathy according to the Bernuau system is as follows.<ref name="Mochida-2008">{{Cite journal  | last1 = Mochida | first1 = S. | last2 = Nakayama | first2 = N. | last3 = Matsui | first3 = A. | last4 = Nagoshi | first4 = S. | last5 = Fujiwara | first5 = K. | title = Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis. | journal = Hepatol Res | volume = 38 | issue = 10 | pages = 970-9 | month = Oct | year = 2008 | doi = 10.1111/j.1872-034X.2008.00368.x | PMID = 18462374 }}</ref>
====Fulminant====
Fulminant encephalopathy is an encephalopathy that occurs within 8 weeks of onset of jaundice.
====Late-Onset====
Late onset encephalopathy is an encephalopathy that occurs within an interval of 8 to 24 weeks from onset of jaundice.
====Acute====
Acute encephalopathy is an encephalopathy that occurs within 10 days of onset of jaundice
====Subacute====
Subacute encephalopathy is an encephalopathy that occurs within an interval of 11 to 56 days from onset of jaundice


==References==
==References==

Revision as of 21:32, 26 October 2017

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Overview

Acute liver failure is classified into three subcategories; hyperacute , acute, and subacute depending upon the time lapsed between the appearance of jaundice, to the development of encephalopathy. In can also be classified into fulminant and subfulminant based upon the time that has lapsed from the start if illness to the onset of encephalopathy.

Classification

Acute liver failure may be classified on the basis of the duration of the symptoms between the onset of jaundice to the onset of encephalopathy. The different classification systems based on the number of weeks from the appearance of jaundice to the encephalopathy are:[1] [2][3][4][5][6]

Classification system Duration
O’Grady System
  • Hyperacute (0 - 1 week)
  • Acute ( From 2nd week - 4 weeks)
  • Subacute ( From 4th week - 12 weeks)
Bernuau System
  • Fulminant ( 0 - 2 weeks)
  • Subfulminant ( 2 weeks - 12 weeks)
Japanese System
  • Fulminant (0 - 8 weeks)
    • Acute ( 0 - 1.5 weeks)
    • Subacute ( 1.5 weeks - 8 weeks)
  • Late-Onset ( 8 weeks - 12 weeks)

References

  1. ↑ O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet 1993;342:273-5. PMID 8101303.
  2. ↑ O'Grady JG (2005). "Acute liver failure". Postgraduate medical journal. 81 (953): 148–54. doi:10.1136/pgmj.2004.026005. PMID 15749789.
  3. ↑ Williams R (1996). "Classification, etiology, and considerations of outcome in acute liver failure". Seminars in Liver Disease. 16 (4): 343–8. doi:10.1055/s-2007-1007247. PMID 9027947. Retrieved 2012-10-26. Unknown parameter |month= ignored (help)
  4. ↑ O'Grady, JG.; Schalm, SW.; Williams, R. (1993). "Acute liver failure: redefining the syndromes". Lancet. 342 (8866): 273–5. PMID 8101303. Unknown parameter |month= ignored (help)
  5. ↑ Bernuau, J.; Rueff, B.; Benhamou, JP. (1986). "Fulminant and subfulminant liver failure: definitions and causes". Semin Liver Dis. 6 (2): 97–106. doi:10.1055/s-2008-1040593. PMID 3529410. Unknown parameter |month= ignored (help)
  6. ↑ Mochida, S.; Nakayama, N.; Matsui, A.; Nagoshi, S.; Fujiwara, K. (2008). "Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis". Hepatol Res. 38 (10): 970–9. doi:10.1111/j.1872-034X.2008.00368.x. PMID 18462374. Unknown parameter |month= ignored (help)

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