1.0.0.0 Rec­om­men­da­tions and GRADE

1.1.0.0 Rec­om­men­da­tions

Sr. no.

Rec­om­men­da­tions

SoR

QoE

1

In pa­tients pre­sent­ing with ALF, the AGA sug­gests against rou­tine­ly test­ing all pa­tients for Wil­son’s dis­ease

Com­ment: In a set­ting of high clin­i­cal sus­pi­cion, test­ing for Wil­son’s dis­ease can be con­sid­ered, keep­ing in mind the low pos­i­tive pre­dic­tive value

Al­though the man­age­ment and out­come of ALF would not be al­tered, iden­ti­fi­ca­tion of Wil­son’s dis­ease would allow ap­pro­pri­ate post-‍trans­plan­ta­tion man­age­ment and screen­ing of the pa­tient’s fam­i­ly mem­bers

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 1

2

In pa­tients pre­sent­ing with ALF, the AGA sug­gests test­ing for HSV and treat­ment of pa­tients with HSV

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 2

3

In im­muno­com­pe­tent pa­tients pre­sent­ing with ALF, the AGA sug­gests against rou­tine­ly test­ing all pa­tients for VZV

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 3

4

In preg­nant women pre­sent­ing with ALF, the AGA sug­gests test­ing for hep­ati­tis E

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 4

5

In pa­tients pre­sent­ing with ALF, the AGA sug­gests using the MELD score rather than the KCC as a prog­nos­tic scor­ing sys­tem.

Com­ment: A MELD score of 30.5 (fixed cut-‍off level) should be used for prog­no­sis; high­er scores pre­dict the need for liver trans­plan­ta­tion

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 5

6

In pa­tients pre­sent­ing with ALF, the AGA sug­gests against the rou­tine use of liver biop­sy

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 6

7

In pa­tients pre­sent­ing with ALF, the AGA sug­gests au­toan­ti­body test­ing for au­toim­mune hep­ati­tis be per­formed

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 7

8

In pa­tients pre­sent­ing with ALF, the AGA sug­gests against the em­pir­ic use of treat­ments to re­duce ICP.

Cond

V Low

Ev­i­dence for Rec­om­men­da­tion 8

9

In pa­tients pre­sent­ing with ALF, the AGA rec­om­mends that ex­tra­cor­po­re­al ar­ti­fi­cial liver sup­port sys­tems only be used with­in the con­text of a clin­i­cal trial

N/A

N/A

Ev­i­dence for Rec­om­men­da­tion 9

10

In pa­tients pre­sent­ing with ac­etaminophen-‍as­so­ci­at­ed ALF, the AGA rec­om­mends the use of NAC in ac­etaminophen-‍as­so­ci­at­ed ALF

Strong

V Low

Ev­i­dence for Rec­om­men­da­tion 10

11

In pa­tients pre­sent­ing with non–ac­etaminophen-‍as­so­ci­at­ed ALF, the AGA rec­om­mends that NAC only be used in the con­text of clin­i­cal tri­als

N/A

N/A

Ev­i­dence for Rec­om­men­da­tion 11

SoR: Strength of Rec­om­men­da­tion
QoE: Qual­i­ty of Ev­i­dence
Strong: Strong Rec­om­men­da­tion
Cond: Con­di­tion­al Rec­om­men­da­tion
High: High-‍Qual­i­ty Ev­i­dence
Mod: Mod­er­ate-Qual­i­ty Ev­i­dence
Low: Low-‍Qual­i­ty Ev­i­dence
V Low: Very Low-‍Qual­i­ty Ev­i­dence