Diagnostic criteria of acute liver failure: A report by the Intractable Hepato-Biliary Diseases Study Group of Japan

Satoshi Mochida, Yasuhiro Takikawa, Nobuaki Nakayama, Makoto Oketani, Takafumi Naiki, Yoshiyuki Yamagishi, Takafumi Ichida, Hirohito Tsubouchi

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105 Citations (Scopus)


The diagnostic criteria of fulminant hepatitis in Japan are different from those of acute liver failure in Europe and the United States, both in regard to the histological features in the liver and the cutoff values of the prothrombin time. Thus, the Intractable Hepato-Biliary Disease Study Group established novel diagnostic criteria for "acute liver failure" in Japan based on the demographic and clinical features of the patients. Patients showing prothrombin time values of 40% or less of the standardized values or international normalized ratios of 1.5 or more caused by severe liver damage within 8weeks of onset of the symptoms are diagnosed as having "acute liver failure", where the liver function prior to the current onset of liver damage is estimated to be normal. Acute liver failure is classified into "acute liver failure without hepatic coma" and "acute liver failure with hepatic coma," depending on the severity of the hepatic encephalopathy; the latter is further classified into two types, the "acute type" and the "subacute type", in which grade II or more severe hepatic coma develops within 10days and between 11 and 56days, respectively, after the onset of disease symptoms. Patients without histological findings of hepatitis, such as those with liver damage caused by drug toxicity, circulatory disturbance or metabolic disease, are also included in the disease entity of "acute liver failure", while acute-on-chronic liver injuries, such as liver injury caused by alcohol, are excluded. A nationwide survey of "acute liver failure" in Japan based on the novel criteria is proposed.

Original languageEnglish
Pages (from-to)805-812
Number of pages8
JournalHepatology Research
Issue number9
Publication statusPublished - 2011 Sept


  • Acute liver failure
  • Diagnostic criteria
  • Fulminant hepatitis
  • Hepatic encephalopathy
  • Late onset hepatic failure

ASJC Scopus subject areas

  • Hepatology
  • Infectious Diseases


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