Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure.
One hundred thirty-seven patients with fulminant hepatic failure were entered into two controlled trials of charcoal hemoperfusion carried out concurrently. In trial A, 75 patients with grade 3 encephalopathy were randomized to receive 5 or 10 h of hemoperfusion daily. Overall survival rates for the two groups were similar (51.3% vs. 50.0%) as was the frequency of major complications including cerebral edema and renal failure. In trial B, in which 62 patients with established grade 4 encephalopathy on admission were randomized to a no-perfusion group or to have 10 h of hemoperfusion daily, overall survival rates for the two groups were again similar (39.3% and 34.5%, respectively). There was in both trials a significant relationship between survival and etiology quite independent of the use or duration of hemoperfusion. Thus, percentage survival for the acetaminophen-overdose cases was 52.9%, for hepatitis A 66.7%, for hepatitis B 38.9%, for presumed non-A, non-B hepatitis 20%, and for halothane or drug reaction 12.5%. Within the etiologic subgroups survival was also influenced by the three major complications that developed, being inversely related to their frequency and combination, except in the non-A, non-B hepatitis and halothane or drug reaction subgroups, which had a high mortality throughout. In the latter cases particularly, orthotopic liver transplantation merits early consideration and in the group with better "intrinsic" survival (acetaminophen, hepatitis A and B) intensive management of complications (rather than charcoal hemoperfusion) would appear to be of major importance.
O'Grady
J G
JG
Liver Unit, King's College Hospital, London, United Kingdom.
Gimson
A E
AE
O'Brien
C J
CJ
Pucknell
A
A
Hughes
R D
RD
Williams
R
R
D000082:Acetaminophen / Q000506:poisoning; D000293:Adolescent; D000328:Adult; D000368:Aged; D002606:Charcoal; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D006221:Halothane / Q000009:adverse effects; D006464:Hemoperfusion; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011897:Random Allocation
D002606:Charcoal; D000082:Acetaminophen; D006221:Halothane