Clinical features of fulminant hepatitis in Nagasaki Prefecture, Japan.
OBJECTIVE
Fulminant hepatitis is a rare but fatal disease. In the present study, we examined the changes in etiology and prognosis of fulminant hepatitis in Nagasaki Prefecture, Japan between 1980 to 1999.


METHODS
Eighty-one patients with fulminant hepatitis admitted to our hospitals from 1980 to 1999 were examined with respect to the etiology and prognosis.


RESULTS
Fulminant hepatitis was due to hepatitis A virus in 2 (12%) cases, hepatitis B virus in 18 (22%) cases, unknown etiology in 50 (62%) cases, and drug-induced in 11(14%) cases. The number of cases in the first half of the study (1980-1989) was 47 and that of the latter half (1990-1999) was 34 cases. The incidence of fulminant hepatitis type B also decreased from 14 cases (30%) to 4 cases (12%) during these periods. The overall survival rate of fulminant hepatitis was 32%; it was equal in fulminant hepatitis type B, fulminant hepatitis of unknown etiology and fulminant drug-induced hepatitis. The survival rate of fulminant hepatitis type A was 100%, though only two cases were identified. Retrospectively, the survival rate in patients with a pre-encephalopathy period of < or = 10 days and aged < or = 39 years was significantly higher than in patients > or = 40 years of age (p<0.01). There was no difference between the two age groups when pre-encephalopathy period was > or = 11 days.


CONCLUSIONS
The incidence of fulminant hepatitis especially that of fulminant hepatitis type B in Nagasaki Prefecture has decreased in recent years. The survival rate is significantly higher in younger patients with a short pre-encephalopathy period.
Kato
Y
Y
First Department of Internal Medicine, Nagasaki University School of Medicine.
Nakata
K
K
Omagari
K
K
Kusumoto
Y
Y
Mori
I
I
Furukawa
R
R
Tanioka
H
H
Tajima
H
H
Yano
M
M
Eguchi
K
K
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D002648:Child; D005260:Female; D005934:Glucagon / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000401:mortality; D006505:Hepatitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012189:Retrospective Studies; D015996:Survival Rate; D014505:Urban Population
D000305:Adrenal Cortex Hormones; D007328:Insulin; D005934:Glucagon