P- 55 ACUTE LIVER FAILURE IN PERU: EPIDEMIOLOGY AND PROBLEMATIC OF SUPPORT AND MANAGEMENT

Introduction and Objectives

Acute liver failure (ALF) is a severe clinical entity that requires a rapid diagnosis and for its proper management requires adequate intensive care support and the possibility of liver transplantation. This study aimed to show clinical epidemiological characteristics of ALF and the problematics of its management in Peru.

Materials and Methods

Google forms electronic survey answered (February-March 2023) by specialists who work in hospitals that care for patients with ALF throughout Peru with the sponsorship of 3 Peruvian scientific societies: intensive care (SOPEMI), Transplant (APTOT) and Hepatology (APEH).

Results

Representatives of 33 public and private hospital centers from the entire health services system responded the survey: Adults: 27/33 (81.8%) and Pediatrics: 6/33 (18.2%). ALF criteria diagnosis: severe acute liver injury with encephalopathy and impaired synthetic function (INR >=1.5) in a patient with preexisting liver disease and with an illness < 26 weeks duration. Geographical regions: Lima (12 million inhabitants: 66.7%) and 7 other regions of Peru: Arequipa, La Libertad, Junin, Tacna, Cajamarca, Huanuco & Puno (9 million inhabitants: 33.3%). Specialties: ICU: 36.4%, GI/hepatology: 30.3%, emergency: 15.2%, Pediatric CU: 9.1%. Male/female ratio 2-3/1: 57.6%. ICU stay: <1 week: 12.1%, <4 weeks: 57.6%, 4-8 weeks: 21.2%, > 8 weeks: 10.1%. ALF Diagnostic Criteria severity: MELD: 54.5%. Kings: 24.2%. Clichy: 3%. Possibility of being transferred to a transplant center: 51.5%. ALF Mortality: Multiorgan failure: 90.9%. ICU with multi-organ support: 57.6%.

Conclusions

ALF in Peru is a serious entity that especially affects the adult population, with high mortality, limited access and limited possibility of liver transplantation. It is necessary to have adequate resources from the government and scientific societies (SOPEMI, APTOT and APEH) to adequately attend this entity which requires support from human resources and adequate care from multidisciplinary health team.