What's new in the critical care management of acute liver failure: a focus on global accessibility.

INTRODUCTION: Acute liver failure (ALF) is a rare syndrome characterized by acute severe liver dysfunction and hepatic encephalopathy. The etiology of ALF varies according to age and geographical distribution and hence management depends on the etiology and clinical condition.

AREAS COVERED: While high-income-countries (HIC) most often see acetaminophen (APAP) and drug-induced liver injury (DILI) as causes of ALF, low-middle-income countries (LMIC) face a higher burden of viral hepatitis (particularly hepatitis A and E virus) and herbal/traditional/toxin medicine-related ALF transplant-free survival from ALF continues to improve with corresponding reduced rates of intracranial hypertension and cerebral edema particularly in APAP-ALF.

EXPERT OPINION: In this review, we will provide an update on the epidemiology and management of ALF with a particular focus on the differences in worldwide populations.