Gastroenterology

Gastroenterology

Volume 97, Issue 2, August 1989, Pages 439-445
Gastroenterology

Early indicators of prognosis in fulminant hepatic failure

https://doi.org/10.1016/0016-5085(89)90081-4Get rights and content

Abstract

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 < 7.30, prothrombin time >100 s, and creatinine >300 μmol/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 <11 and >40 yr, duration of jaundice before the onset of encephalopathy >7 days] and two dynamic variables (serum bilirubin >300 μmol/L and prothrombin time >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.

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This work was presented to the European Association for the Study of the Liver in August 1988.

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