Early indicators of prognosis in fulminant hepatic failure

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 97; no. 2; p. 439
• Main Authors: O'Grady, J G, Alexander, G J, Hayllar, K M, Williams, R
• Format: Journal Article
• Language: English
• Published: United States 01.08.1989
• Subjects: Acetaminophen - poisoning; Adult; Chemical and Drug Induced Liver Injury - complications; Child; Drug Hypersensitivity - complications; Halothane - adverse effects; Hepatitis, Viral, Human - complications; Humans; Liver Diseases - etiology; Liver Diseases - mortality; Liver Transplantation; Prognosis; Retrospective Studies; Risk Factors; Statistics as Topic
• ISSN: 0016-5085
• DOI: 10.1016/0016-5085(89)90081-4

The successful use of orthotopic liver transplantation in fulminant hepatic failure has created a need for early prognostic indicators to select the patients most likely to benefit at a time when liver transplantation is still feasible. Univariate and multivariate analysis was performed on 588 patients with acute liver failure managed medically during 1973-1985, to identify the factors most likely to indicate a poor prognosis. In acetaminophen-induced fulminant hepatic failure, survival correlated with arterial blood pH, peak prothrombin time, and serum creatinine--a pH less than 7.30, prothrombin time greater than 100 s, and creatinine greater than 300 mumol/L indicating a poor prognosis. In patients with viral hepatitis and drug reactions three static variables [etiology (non A, non B hepatitis or drug reactions), age less than 11 and greater than 40 yr, duration of jaundice before the onset of encephalopathy greater than 7 days] and two dynamic variables (serum bilirubin greater than 300 mumol/L and prothrombin time greater than 50 s) indicated a poor prognosis. The value of these indicators in determining outcome was tested retrospectively in a further 175 patients admitted during 1986-1987, leading to the construction of models for the selection of patients for liver transplantation.